HIV患者尿液菌谱特征及其影响因素分析

Analysis of the characteristics of urinary pathogenic bacteria and its influencing factors in HIV patients

目的:探讨HIV患者泌尿系感染的菌谱特点及相关因素。方法:回顾性分析2012年1月~2017年12月收治的832例患者的临床资料,男490例,女342例。所有患者中段尿培养结果均为阳性。将患者按照是否感染HIV分为HIV组、非HIV组;HIV患者按照CD4细胞计数分组:A组<200个/μL,B组200~400个/μL,C组>400~600个/μL,D组>600个/μL。HIV患者按血红蛋白数量分组A组(30~60 g/L),B组(>60~90 g/L),C组(>90~120 g/L),D组(>120 g/L)。比较不同CD4细胞、血红蛋白的HIV患者合并泌尿系感染的中段尿细菌培养的菌谱特点。结果:本组832例患者中段尿细菌培养最常见的4种尿路细菌为:大肠埃希菌317株(38.1%),其他的依次为肺炎克雷伯菌207株(24.9%),奇异变形菌124(14.9%),不动杆菌属48株(5.8%)。HIV患者的铜绿假单胞菌18株(5.0%)、粪肠球菌19株(5.3%)、屎肠球菌25株(6.9%)的比例明显高于非HIV患者的11株(2.3%)、12株(2.5%)和17株(3.6%),差异有统计学意义(P<0.05)。HIV组的病例按CD4细胞计数分组,A组的大肠埃希菌60株(37.3%)比例明显高于C组15株(19.0%)和D组5株(35.7%),差异有统计学意义(P<0.05)。C组的肺炎克雷伯杆菌26株(33.0%)比例明显高于D组2株(14.3%),差异有统计学意义(P<0.05)。尿培养阳性的HIV患者随着血红蛋白的增加呈增多趋势,血红蛋白120 g/L以上,尿培养阳性的HIV患者则明显减少。结论:HIV合并泌尿系感染患者的尿液细菌有独特的分布特征,受包括CD4细胞计数、血红蛋白等在内的多种因素影响。大肠埃希菌是HIV患者最常见的尿路细菌,铜绿假单胞菌更多见于HIV患者。伴随CD4细胞数量的增加,HIV患者泌尿系感染例数逐渐减少,血红蛋白120 g/L是影响泌尿系感染的重要界限。

Objective:To investigate the characteristics of bacterial distribution associated with urinary tract infection in HIV patients.Method:The study retrospectively analyed results of positive bladder mid-stream urine culure from 832 cases with urinary tract infection between January 2012 and December 2017 in Eighth People’s Hospital of Guangzhou.There were 342 female patients and 490 male patients.Patients were grouped by whether or not to infect HIV;HIV patients were stratified in four different CD4 cells count groups:A<200 cells/μL;B 200-400 cells/μL;C>400-600 cells/μL;D>600 cells/μL and in four different hemoglobin groups:A 30-60 g/L;B>60-90 g/L;C>90-120 g/L;D>120 g/L.Microbial distribution of uropathogens in HIV patients were analysed on the basis of results of the urine culture in different CD4 cells count and hemoglobin.Result:The four most common uropathogens were Escherichia coli(317 strains;38.1%),Klebsiella pneumoniae(207 strains;24.9%),Proteus mirabilis(124 strains;14.9%)and Acinetobacter(48 strains;5.8%).The occurrence of Pseudomonas aeruginosa(18 strains;5.0%vs 11 strains;2.3%),Enterococcus faecalis(19 strains;5.3%vs 12 strains;2.5%),Enterococcus faecium(25 strains;6.9%vs 17 strains;3.6%)in HIV patients were higher than those in non-HIV patients(P<0.05).HIV patients were grouped by number of CD4 cells.Escherichia coli was more frequent in group A(60 strains;37.3%)than that in group C(15 strains;19.0%),D(5 strains;35.7%);(P<0.05).Klebsiella pneumoniae was more frequent in group C(26 strains;33.0%)than that in group D(2 strains;14.3%);(P<0.05).The number of HIV patients with urine culture positive showed an increasing trend with the increase of hemoglobin,but significantly reduced when hemoglobin is above 120 g/L.Conclusion:The uropathogens in HIV patients had a unique distribution,and influenced by many factors including CD4 cell count,hemoglobin and so on.Escherichia coli was the most common uropathogen in HIV patients with urinary tract infection.Pseudomonas aeruginosa was more frequent in HIV patients.As the number of CD4 cells increases,the number of urinary tract infection in HIV patients gradually decreases,and hemoglobin 120 g/L is an important limit affecting urinary tract infection.