2型糖尿病合并尿路感染的危险因素及病原学分析

Risk factors and etiological characteristics of urinary tract infection in type 2 diabetes mellitus

目的观察T2DM合并尿路感染病原菌分布特点和药敏结果,并探讨其发生的危险因素。方法分析T2DM合并尿路感染患者的临床特点及病原学特征。结果 T2DM合并尿路感染的发生率为6.85%(210/3065),T2DM合并尿路感染组较T2DM组年龄大、病程长,FPG,尿素氮、肌酐及24h尿白蛋白(24hUAlb)水平高,白蛋白水平低(P<0.05)。Logistic回归分析显示,女性、年龄、糖尿病病程、24hUAlb是发生尿路感染的危险因素,白蛋白为保护因素。分离出的210株病原菌以革兰氏阴性菌为主(84.2%),前3种病原菌为大肠埃希菌(65.2%)、粪肠球菌(6.2%)和肺炎克雷伯菌(5.2%)。革兰氏阴性菌对亚胺培南(100%)、头孢哌酮舒巴坦(99.2%)和阿米卡星(99.2%)敏感性较高,对头孢噻吩(38.1%)、哌拉西林(35.7%)和阿莫西林(28.2%)敏感性较低。结论老年、女性、糖尿病病程长及肾功能不全的T2DM患者更易发生尿路感染,T2DM合并尿路感染的病原菌仍以革兰氏阴性菌为主,但细菌谱发生了一定的变化,且多重耐药菌呈明显上升趋势。

Objective To explore the risk factors for urinary tract infections in type 2 diabetes mellitus（T2DM）by analyzing the pathogens distribution characteristics and drug sensitivity. MethodsA total of 3,065 T2DM patients were retrospectively analyzed for the clinical and etiological characteristics of urinary tract infections in T2DM.All patients enrolled in the study were divided into two groups：T2DM with urinary tract infection group（n=210）and simple T2DM group（n=132）.Data harvested were analyzed by SPSS 19.0. Results Of 3,065 patients with T2DM the incidence of urinary tract infection was 6.85%.Compared with T2DM group,patients in T2DM＋ urinary tract infection group were older,with longer duration of diabetes,higher levels of FPG,urea nitrogen,creatinine and 24 hUAlb,and lower levels of serum albumin（P〈0.05）.Logistic regression analysis showed that age,gender,duration of diabetes and 24 hUAlb were risk factors and albumin was protective factor for urinary tract infection in T2DM.84.2% was gram-negative bacteria among the 210 isolated strains of pathogenic bacteria.The top three pathogens were Escherichia coli（65.2%）,Enterococcus faecalis（6.2%）and Klebsiella pneumoniae（5.2%）.Gram-negative bacteria had high sensitivity to Imipenem（100%）,Cefoperazone sulbactam（99.2%）and Amikacin（99.2%）but low sensitivity to cephalothin（38.1%）,piperacillin（35.7%）and amoxicillin（28.2%）. Conclusion T2DM patients who have the factors including female,advanced age,long course of diabetes and renal insufficiency are prone to suffer from urinary tract infection.Gramnegative bacteria are the most common pathogens in T2DM patients with urinary tract infection but bacteria spectrum has changed with percentage of multiple resistant bacteria rising dramatically.