脊髓损伤术后导尿管相关尿路感染多药耐药菌及其影响因素  

Multiple drug-resistant bacteria and its influencing factors of postoperative catheter-related urinary tract infection in patients with spinal cord injury

作　　者：张晓丹 包丹丹[1] 李茜 何庆权[1] 宋杨 ZHANG Xiao-dan;BAO Dan-dan;LI Xi;HE Qing-quan;SONG Yang(Shengjing Hospital Affiliated to China Medical University,Shenyang,Liaoning 110004,China)

机构地区：[1]中国医科大学附属盛京医院康复中心,辽宁沈阳110004

出　　处：《中华医院感染学杂志》2023年第3期429-433,共5页Chinese Journal of Nosocomiology

基　　金：辽宁省科研基金资助项目(2020L02110)。

摘　　要：目的 探究脊髓损伤术后导尿管相关尿路感染多药耐药菌(MDRO)及其影响因素。方法 回顾性分析2019年1月-2020年8月于中国医科大学附属盛京医院康复中心住院的85例脊髓损伤长期留置导尿管尿路感染患者的临床资料,采用多元Logistic回归模型分析脊髓损伤术后导尿管相关尿路感染MDRO的影响因素。结果 85例患者共检出病原菌157株,其中革兰阴性菌83株占52.87%,革兰阳性菌45株占28.66%,真菌29株占18.47%,以大肠埃希菌、屎肠球菌、白假丝酵母为主;共检出多药耐药菌43株,包括产超广谱β-内酰胺酶肠杆菌科细菌(ESBLs-ECO)、耐万古霉素肠球菌(VRE)、耐甲氧西林金黄色葡萄球菌(MRSA)、耐碳青霉烯肠杆菌科细菌(CRE)、多重耐药铜绿假单胞菌(MRPA)、耐碳青霉烯鲍氏不动杆菌(CRAB)及产超广谱β-内酰胺酶肺炎克雷伯菌(ESBLs-KPN);多元Logistic回归分析显示:留置导尿管时间、住院期间插导尿管次数、抗菌药物用药史和住院时间是脊髓损伤术后导尿管相关尿路感染MDRO的影响因素(P<0.05)。结论 脊髓损伤长期留置导尿管患者尿路感染耐药菌较多,针对病原菌特点及感染影响因素,制定合理有效的预防和治疗措施,尽可能降低感染发生率。OBJECTIVE To investigate multiple drug-resistant organisms(MDRO) in catheter-associated urinary tract infections after spinal cord injury surgery and and its influencing factors.METHODS The clinical data of 85 patients with long-term indwelling catheter urinary tract infection in spinal cord injury hospitalized in the rehabilitation center of our hospital from Jan.2019 to Aug.2020 were retrospectively analyzed.Multivariate Logistic regression model was used to analyze the factors influencing MDRO of catheter-related urinary tract infection after spinal cord injury surgery.RESULTS A total of 157 strains of pathogenic bacteria were detected in 85 patients,of which 83 strains of Gram-negative bacteria accounted for 52.87%,45 strains of Gram-positive bacteria accounted for 28.66% and 29 strains of fungi accounted for 18.47%,mainly Escherichia coli,Enterococcus faecium and Candida albicans.A total of 43 strains of multidrug resistant bacteria were detected,including ultra-broad spectrum β-lactamase-producing Enterobacteriaceae(ESBLs-ECO),vancomycin-resistant Enterococcus(VRE),methicillin-resistant Staphylococcus aureus(MRSA),carbapenem-resistant Enterobacteriaceae(CRE),multi-drug resistant Pseudomonas aeruginosa(MRPA),carbapenem-resistant Acinetobacter baumannii(CRAB) and ultra-broad spectrum β-Lactamase Klebsiella pneumoniae(ESBLs-KPN).Multivariate Logistic regression analysis showed that the time of indwelling catheter,number of catheter insertions during hospitalization,history of antibiotic use and length of hospital stay were the influencing factors of MDRO for catheter-related urinary tract infection in patients with spinal cord injury(P<0.05).CONCLUSION There are many drug-resistant bacteria in urinary tract infections in patients with long-term indwelling catheter for spinal cord injury.Reasonable and effective prevention and treatment measures should be formulated to minimize the incidence of infection according to the characteristics of pathogenic bacteria and infection-related influencing factors.

关 键 词：脊髓损伤 神经源性下尿路功能障碍 导尿管 尿路感染 多药耐药菌 术后感染:影响因素 

分 类 号：R691.3[医药卫生—泌尿科学]