神经源膀胱患者康复期间尿路感染影响因素  

Influencing factors for urinary tract infection in patients with neurogenic bladder during rehabilitation

作　　者：程慧佳 贾杰 李玲 刘小曼 杨颖[1] CHENG Hui-jia;JIA Jie;LI Ling;LIU Xiao-man;YANG Ying(People's Hospital of Suzhou High-tech Zone,Suzhou,Jiangsu 215129,China;不详)

机构地区：[1]苏州高新区人民医院康复医学科,江苏苏州215129 [2]上海市复旦大学附属华山医院康复医学科,上海200040

出　　处：《中华医院感染学杂志》2022年第8期1153-1156,共4页Chinese Journal of Nosocomiology

基　　金：国家重点研发计划主动健康和老龄化科技应对重点专项(2018YFC2002300)。

摘　　要：目的 探究神经源膀胱患者康复期间尿路感染影响因素。方法 回顾性分析2016年10月-2020年10月期间医院收治的神经源膀胱患者资料,调查患者康复期间尿路感染率、病原菌分布及耐药性,分析患者尿路感染影响因素。结果 80例患者出现尿路感染34例,尿路感染率42.50%;52株病原菌中革兰阴性菌31株(59.62%),主要为大肠埃希菌与铜绿假单胞菌,革兰阳性菌18株(34.62%),主要为粪肠球菌与金黄色葡萄球菌,真菌3株(5.77%);大肠埃希菌对头孢呋辛、美洛西林、氨苄西林以及头孢克洛耐药株数分别为16、13、12、11株,铜绿假单胞菌对头孢唑林、头孢呋辛、头孢替坦、氨苄西林、呋喃妥因耐药株数分别为9、9、8、7、7株,粪肠球菌对红霉素、克林霉素耐药株数分别为10、9株;多元Logistic回归分析显示糖尿病、低蛋白血症、导管留置时间长为患者尿路感染发生危险因素,而预防性应用抗生素是患者尿路感染保护因素(P<0.05)。结论 神经源膀胱患者康复期尿路感染主要为革兰阴性菌,对多种抗菌药物耐药,尿路感染发生易受糖尿病、低蛋白血症、导管留置时间以及预防性应用抗菌药物等影响。OBJECTIVE To explore the influencing factors for urinary tract infection in patients with neurogenic bladder during rehabilitation. METHODS The data of patients with neurogenic bladder admitted to the hospital between Oct 2016 and Oct 2020 was retrospectively analyzed. The incidence of urinary tract infection during rehabilitation, distribution and drug resistance of pathogenic bacteria were investigated. The influencing factors for urinary tract infection were analyzed. RESULTS Urinary tract infection occurred in 34 out of 80 patients, with an incidence of 42.50%. All 52 pathogenic bacteria strains were isolated, 31 of which(59.62%) were Gram-negative bacteria strains and Escherichia coli and Pseudomonas aeruginosa were the main strains;18 strains(34.62%) were Gram-positive bacteria, mainly including Enterococcus faecalis and Staphylococcus aureus, and 3 strains(5.77%) were fungi. The number of E. coli strains resistant to cefuroxime, mezlocillin, ampicillin and cefaclor were 16, 13, 12 and 11, respectively. The number of P. aeruginosa strains resistant to cefazolin, cefuroxime, cefotetan, ampicillin and nitrofurantoin were 9, 9, 8, 7 and 7, respectively. The number of E. faecalis strains resistant to erythromycin and clindamycin were 10 and 9, respectively. Diabetes, hypoproteinemia, and long catheter indwelling time were risk factors for urinary tract infection, while prophylactic use of antibiotics was a protective factor(P<0.05). CONCLUSION Gram-negative bacteria is the main pathogenic bacteria of urinary tract infection in patients with neurogenic bladder during rehabilitation, with multiple antibiotics resistance. Risk factors of urinary tract infection are diabetes, hypoproteinemia, catheter indwelling time and prophylactic use of antibiotics.

关 键 词：神经源膀胱 尿路感染 病原菌 多元LOGISTIC回归分析 影响因素 

分 类 号：R691.3[医药卫生—泌尿科学]