泌尿系统结石患者尿路感染病原菌分布、耐药性及易感因素分析  

Analysis of Pathogenic Bacteria Distribution,Drug Resistance and Susceptible Factors of Urinary Tract Infection in Patients with Urinary Calculi

作　　者：孙宏宇 程章林 李正叶 SUN Hongyu;CHENG Zhanglin;LI Zhengye(Department of Urology,Xinyang People's Hospital,Xinyang 464000,Henan,China)

机构地区：[1]信阳市人民医院泌尿外科,河南信阳464000

出　　处：《中国药物滥用防治杂志》2024年第7期1220-1223,1235,共5页Chinese Journal of Drug Abuse Prevention and Treatment

基　　金：河南省医学科技攻关计划联合共建项目(编号:LHGJ20221089)。

摘　　要：目的:分析泌尿系统结石患者尿路感染病原菌分布、耐药性及易感因素。方法:回顾性选取2021年1月—2023年12月信阳市人民医院收治的180例泌尿结石患者,根据患者是否发生尿路感染分为未感染组(145例)与感染组(35例),采集感染组尿液标本,进行病原菌培养及药敏试验,并统计两组临床基线资料,对其进行单因素、多因素Logistic回归分析。结果:35例尿路感染患者尿液标本共培养出病原菌32株,剔除其中重复感染菌种后,可发现病原菌分布以革兰阴性菌为主,革兰阳性菌次之,革兰阴性菌中多见大肠埃希菌与铜绿假单胞菌,革兰阳性菌中多见粪肠球菌与屎肠球菌;粪肠球菌及屎肠球菌耐药药物均为庆大霉素、青霉素G及红霉素,粪肠球菌敏感药物为万古霉素及替考拉宁,屎肠球菌敏感药物为万古霉素、替考拉宁、氨苄西林;大肠埃希菌耐药药物为氨苄西林、头孢唑林、头孢他啶,铜绿假单胞菌耐药药物为头孢唑林、氨苄西林、头孢曲松,两者敏感药物均为亚胺培南;感染组年龄≥60岁、有吸烟史、合并基础疾病≥2种、留置导尿管时间≥3 d、结石直径≥3 mm患者占比均高于对照组;多因素Logistic回归分析结果显示,年龄≥60岁、有吸烟史、合并基础疾病≥2种、留置导尿管时间≥3 d、结石直径≥3 mm为泌尿系统结石患者发生尿路感染的危险因素(OR=3.773,3.320,1.927,1.964,2.300,P<0.05)。结论:泌尿系统结石患者尿路感染主要病原菌为大肠埃希菌、铜绿假单胞菌、粪肠球菌与屎肠球菌,且不同病原菌间均具有不同的耐药差异,可定期检测病原菌分布及耐药情况,促进临床抗菌药物合理使用,并可根据讨论中所得内容及结果尽早确诊并给予相关干预措施,进而降低尿路感染发生风险。Objective:To analyze the distribution,drug resistance and susceptible factors of pathogenic bacteria of urinary tract infection in patients with urinary calculi.Methods:A total of 180 patients with urinary calculi admitted to Xinyang People's Hospital from January 2021 to December 2023 were retrospectively selected.According to whether the patients had urinary tract infection,they were divided into uninfected group(145 patients)and infected group(35 patients).The urine samples of the infected group were collected for pathogen culture and drug sensitivity test,and the clinical baseline data of the two groups were counted.Univariate and multivariate Logistic regression analysis was performed.Results:A total of 32 strains of pathogenic bacteria were cultured from urine samples of 35 patients with urinary tract infection.After eliminating the repeated infection strains,it was found that the distribution of pathogenic bacteria was mainly Gram-negative bacteria,followed by Gram-positive bacteria.Escherichia coli and Pseudomonas aeruginosa were more common in Gram-negative bacteria,and Enterococcus faecalis and Enterococcus faecium were more common in Gram-positive bacteria.The resistant drugs of Enterococcus faecalis and Enterococcus faecium were gentamicin,penicillin G and erythromycin.The sensitive drugs of Enterococcus faecalis were vancomycin and teicoplanin.The sensitive drugs of Enterococcus faecium were vancomycin,teicoplanin and ampicillin.The drug-resistant drugs of Escherichia coli were ampicillin,cefazolin and ceftazidime,and the drug-resistant drugs of Pseudomonas aeruginosa were cefazolin,ampicillin and ceftriaxone.Both sensitive drugs were imipenem.The proportion of patients with age≥60 years old,smoking history,combined basic diseases≥2,indwelling catheter time≥3 d,stone diameter≥3 mm in the infection group was higher than that in the control group.Multivariate Logistic regression analysis showed that age≥60 years,smoking history,combined basic diseases≥2,indwelling catheter time≥3 d,stone

关 键 词：泌尿系统结石 尿路感染 病原菌分布 耐药性 易感因素 

分 类 号：R691.4[医药卫生—泌尿科学] R446.5[医药卫生—外科学]