缺血性脑卒中患者并发尿路感染的病原菌分布、临床特点及危险因素  

Pathogenic bacteria distribution,clinical features and risk factors of urinary tract infection in patients with ischemic stroke

作　　者：田沛 范荣富 王洪岩 彭明丽 TIAN Pei;FAN Rongfu;WANG Hongyan;PENG Mingli(Department of Pharmacology,Beijing Bo'ai Hospital,China Rehabilitation Research Center,Beijing 100068,China;Department of General Surgery,Beijing Bo'ai Hospital,China Rehabilitation Research Center,Beijing 100068,China;Department of Nosocomial Infection,Beijing Bo'ai Hospital,China Rehabilitation Research Center,Beijing 100068,China)

机构地区：[1]中国康复研究中心北京博爱医院药剂科,北京市100068 [2]中国康复研究中心北京博爱医院普外科,北京市100068 [3]中国康复研究中心北京博爱医院感染科,北京市100068

出　　处：《中国康复理论与实践》2024年第10期1179-1186,共8页Chinese Journal of Rehabilitation Theory and Practice

摘　　要：目的探讨缺血性脑卒中患者发生尿路感染的病原菌分布、临床特点及危险因素。方法回顾性调查2020年1月至2023年12月期间北京博爱医院634例缺血性脑卒中患者的临床资料,根据是否并发尿路感染分为对照组(n=551,未并发尿路感染)和观察组(n=83,并发尿路感染)。统计尿路感染发病率、病原菌分布情况、主要致病菌对不同抗菌药物的耐药情况。比较两组临床特点,采用多因素Logistic回归分析缺血性脑卒中患者发生尿路感染的独立危险因素。结果缺血性脑卒中患者尿路感染的发生率为13.09%(83/634)。观察组尿液样本中共分离出127株病原菌,其中革兰氏阴性菌80株(62.99%),革兰氏阳性菌26株(20.47%),真菌21株(16.54%)。主要革兰氏阴性致病菌为大肠埃希菌和肺炎克雷伯菌,其对第二、三代头孢,复方新诺明和左氧氟沙星等耐药率较高,对碳青霉烯类、β-内酰胺酶抑制剂复方制剂、氨基糖苷类等中等耐药,对替加环素、多黏菌素等高度敏感。主要革兰氏阳性致病菌为屎肠球菌和粪肠球菌,其对红霉素、庆大霉素等耐药率较高,对利奈唑胺、达托霉素、替考拉宁及万古霉素等高度敏感。检出的致病真菌对常用抗真菌药物均无明显耐药。观察组女性、糖尿病、留置导尿管、神经源性膀胱占比高于对照组(χ^(2)>5.043,P<0.05)。女性、糖尿病、留置导尿管和神经源性膀胱是缺血性脑卒中患者发生尿路感染的独立危险因素(P<0.05)。结论缺血性脑卒中并发尿路感染患者的致病菌以革兰氏阴性菌为主,其次为革兰氏阳性菌和真菌,且革兰氏阴性菌呈多重耐药。女性、糖尿病、留置导尿管和神经源性膀胱是缺血性脑卒中并发尿路感染的独立危险因素。Objective To investigate the pathogenic bacteria distribution,clinical features and risk factors of urinary tract infection in patients with ischemic stroke.Methods A retrospective study was conducted on 634 patients with ischemic stroke in Beijing Bo'ai Hospital from January,2020 to December,2023.They were divided into control group(n=551,without urinary tract infection)and observation group(n=83,with urinary tract infection)according to whether they developed urinary tract infection.The incidence of urinary tract infection,the distribution of pathogenic bacteria and the resistance of main pathogenic bacteria to different antibacterial drugs were analyzed.The clinical characteristics of the two groups were compared and analyzed.The independent risk factors of urinary tract infection in patients with ischemic stroke were analyzed with multivariate Logistic regression.Results A total of 83 cases of 634 patients with ischemic stroke developed urinary tract infection,and incidence was 13.09%.A total of 127 strains of pathogenic bacteria were isolated from the urine samples of the observation group,of which Gram-negative bacteria accounted for 62.99%(80/127),Gram-positive bacteria accounted for 20.47%(26/127)and strains of fungi accounted for 16.54%(21/127).The main Gram-negative pathogens were Escherichia coli and Klebsiella pneumoniae,which were high resistant to second-generation and third-generation cephalosporins,co-trimoxazole,and levofloxacin;moderately resistant to carbapenems,β-lactamase inhibitor compound preparation and aminoglycosides,etc.;and highly sensitive to tigecycline and polymyxin,etc.The main Gram-positive pathogens were Enterococcus faecalis and Enterococcus faecalis,which were a high resistant to erythromycin and gentamicin,and highly sensitive to linezolid,daptomycin,teicoplanin and vancomycin.The pathogenic fungi detected were not obviously resistant to common antifungal drugs.The proportion of female,diabetes,indwelling catheter and neurogenic bladder were significantly higher in the observ

关 键 词：缺血性脑卒中 尿路感染 菌群分布 临床特点 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]