肾积水对结石患者微生物评价的影响

Influence of hydronephrosis on microbiological evaluation of patients with calculi

目的探讨肾积水对尿结石患者尿液微生物分布和药敏结果的影响。方法收集2012年1月~2015年2月于北京积水潭医院泌尿外科行经皮肾镜碎石术尿结石患者115例,按是否合并肾积水分为肾积水组和无肾积水组,比较两组患者之间膀胱尿培养、肾盂尿培养和血培养及药敏结果之间的差异。结果本组115例患者,92例(80%)患者伴有肾积水,肾盂尿培养阳性在肾积水组与无肾积水组之间比较,差异有统计学意义(P=0.044)。肾积水组膀胱尿培养阳性患者44例(38%),肾盂尿培养培养阳性21例(18%),系统炎症反应综合征31例(27%),血培养阳性5例(4%),在肾积水组,膀胱尿培养和肾盂尿液(k=0.176,P=0.049)以及血培养(k=0.012,P=0.88)培养结果一致性较差;肾盂尿培养与血培养结果一致性较好(k=0.467,P=0.002)。无肾积水组,只有1例患者肾盂尿培养阳性,与尿培养结果一致。肾积水组患者细菌培养最常见的细菌是革兰阴性菌:大肠埃希菌、奇异杆菌和铜绿假单胞菌;在无肾积水组患者尿培养最常见的细菌是革兰阳性菌:粪肠球菌和溶血葡萄球菌。在肾积水组和无肾积水组对革兰阳性菌株最有效的抗生素万古霉素、呋喃妥因、利福平。对革兰阴性菌株最有效的药物是美罗培南、哌拉西林他唑巴坦和阿莫西林-克拉维酸。结论在肾积水时肾盂尿液培养的微生物与膀胱尿液培养的微生物不一致,肾盂尿液培养结果对指导抗生素的使用更有意义。

Objective To evaluate the influence of hydronephrosis on urine microbiological distribution and drug sensi- tivity results of patients with urinary calculi. Methods The data of patients with urinary calculi who underwent pereu- taneous nephrolithotomy in Department of Urology, Beijing Jishuitan Hospital were collected from January 2012 to February 2015. Based on the results of the imaging examination, patients were categorized as either the cases with hy- dronephrosis or the cases without hydronephrosis. The results of the culture from midstream urine, renal pelvic urine and blood, and drug sensitivity between the cases with hydronephrosis or the cases without hydronephrosis were com- pared. Results A total of 115 patients who fulfilled the criteria were recruited. Of these patients 92 patients （80%） had hydronephrosis. There was significant difference between the cases with hydronephrosis and the cases without hy- dronephrosis with regard to positive renal pelvis urine culture （P = 0.044）. In patients with hydronephrosis, 44 cases （38%） had positive midstream urine culture, 21 cases had positive renal pelvic urine culture, 31 cases （27%） had sys- temic inflammatory response syndrome, 5 cases （4%） had positive blood culture. Pathogens colonizing the bladder urine of the patients seemed to differ from those colonizing the renal pelvis urine （k=0.176, P=0.049） and blood （k=0.012, P= 0.88） of the patients with hydronephrosis. The result of renal pelvis urine culture had good consistency with the results of blood Cuhure in patients with hydronephrosis （k =0.467, P=0.002）. In patients without hydronephrosis, 1 case had positive renal pelvic urine culture, which was consistent with the result of bladder urine culture. The most frequent pathogens obtained from the urine culture of the patients with hydronephrosis were Gram-negative bacteria： Escherichia coli, Singular coli and Pseudomonas aeruginosa. The most frequent pathogens obtained from the urine culture of the patients without hydronephrosis were Gram-positive bacteria： Enterococcus and Staphylococcus haemolyticus. In the two groups, the most effective antibiotics against Gram-positive bacteria were Vancomycin, Nitrofurantoin and Ri- fampicin. The most effective antibiotics against Gram-negative bacteria were Meropenem, Piperacillin-tazobactam and Amoxicillin-Clavulanic Acid. Conclusion In patients with hydronephrosis, the microorganism cuhrued in renal pelvis urine is different form cultrued in bladder urine. The re- nal pelvis urine culture results have significance in guid- ing the use of antibiotics.