妊娠期尿路感染相关因素及临床防治

Clinical analysis of urinary tract infections during pregnancy

目的了解妊娠期尿路感染的危险因素、主要病原菌及敏感抗生素，以提高诊治水平。方法选取2008年1月至2014年1月在我院住院的106例妊娠合并尿路感染患者，并选取产科门诊进行产前检查的无尿路感染的孕妇126例进行回顾性研究。结果年龄、孕周、糖尿病、既往尿路感染、泌尿系结石、贫血、流产是妊娠期尿路感染的高危因素，文化程度与妊娠期的尿路感染相关。妊娠期尿路感染病原菌以大肠埃希菌为主（占60．3％）。革兰阴性杆菌对青霉素类及喹诺酮类抗生素耐药率高，对头孢呋辛、头孢唑林、头孢他啶、头孢哌酮、头孢吡肟、亚胺培南、呋哺妥因敏感。革兰阳性球菌对半合成青霉素、喹诺酮类耐药率较高，对头孢呋辛、头孢唑林、头孢他啶、头孢哌酮、头孢吡肟、亚胺培南、呋喃妥因敏感。结论应注意妊娠期尿路感染的高危因素，加强孕期尿液检查及中段尿培养检查，选用敏感、合理的抗菌素治疗。

Objective To explore the risk factors, the main pathogens and antibiotic sensitivity of urinary tract infections during pregnancy to improve the diagnostic level and therapeutic effect. Methods In a retrospective study, 106 pregnant women with urinary tract infections in Xuxi People＇s Hospital from January 2008 to October 2013 were enrolled, and urine culture and drug sensitivity test were analyzed. In addition, 126 pregnant women without urinary tract infection in the maternity clinic were enrolled in the study. Results Age, gestational age, diabetes, history of urinary tract infections, u- rinary stones, anemia, and abortion were the risk factors for urinary tract infections during pregnancy, and education level was associated with urinary tract infections during pregnancy. The predominant bacterial pathogen of urinary tract infections was Escherichia coli （61.3~）, followed by Klebsiella pneumoniae（ 13. 2 %） and Proteus （ 11.8 ~/00）. Gram-negative bacteria were resistant to penicillin and quinolone antibiotics, but sensitive to eefuroxime, cefazolin, ceftazidime, cefoperazone, cefepime, imi- penem, and nitrofurantoirL Gram-positive cocci had a higher resistant rate for semi-synthetic penicillin and quinolone, but sensitive to cefuroxime, cefazolin, ceftazidime, cefoperazone, cefepime, imipenem, and nitrofurantoin. Conclusions It was recommended to strengthen examination with routine urinalysis and test of mid-stream specimen of urine, and the patients with urinary tract infections are treated with sensitive antibiotics.