留置输尿管支架管合并发热性尿路感染男性患者的临床特征研究

Clinical characteristics of male ureteral stent tube indwelling patients complicated with febrile urinary tract infections

目的探讨留置输尿管支架管合并发热性尿路感染男性患者的临床特征。方法选取2013年6月-2017年3月于医院经留置输尿管支架管治疗的1236例男性患者为研究对象,其中合并发热性尿路感染患者为感染组,在未发生发热性尿路感染患者中随机选取100例为未感染组;统计患者一般资料,比较两组患者降钙素原(PCT)、C-反应蛋白(CRP)和白细胞计数等指标,采集感染患者尿液进行病原菌培养和药敏试验。结果 1236例经留置输尿管支架管治疗的患者中合并发热性尿路感染患者76例,感染率为6.15%;感染组CRP、PCT、白细胞计数均高于未感染组(P<0.05);76例留置输尿管支架管合并发热性尿路感染患者共检出病原菌164株,其中革兰阴性菌120株占73.17%,革兰阳性菌32株占19.51%,真菌12株占7.32%;主要革兰阴性菌为大肠埃希菌和肺炎克雷伯菌,主要革兰阳性菌为粪肠球菌和金黄色葡萄球菌;大肠埃希菌和肺炎克雷伯菌对亚胺培南、美罗培南、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦钠和阿米卡星耐药率均较低,对头孢类药物耐药率均>80.00%;粪肠球菌和金黄色葡萄球菌对万古霉素、替加环素和利奈唑胺耐药率为0,对青霉素G和苯唑西林耐药率均>90.00%。结论 CRP、PCT、白细胞计数可以作为留置输尿管支架管患者常规检测指标,用于合并发热性尿路感染的诊断和预防;革兰阴性菌是留置输尿管支架管并发发热性尿路感染的主要致病菌,应及时进行病原菌检测和药敏试验指导治疗。

OBJECTIVE To explore the clinical characteristics of the male ureteral stent tube indwelling patients complicated with febrile urinary tract infections.METHODS A total of 1236 male patients who were treated with ureteral stent tube indwelling in hospitals from Jun 2013 to Mar 2017 were recruited as the study objects, the pa- tients who were complicated with febrile urinary tract infections were assigned as the infection group, and 100 pa- tients were randomly chosen from the patients without febrile urinary tract infection and set as the non-infection group.The baseline data of the patients were statistically analyzed, the levels of procalcitonin （PCT）, C-reactive protein （CRP） and while blood cell counts were compared between the two groups of patients.The urine specimens were collected from the patients with the infections, the isolated pathogens were identified, and the drug suscepti- bility testing was performed.RESULTS Of the 1236 patients who were treated with ureteral stent tube indwelling, 76 were complicated with febrile urinary tract infections, with the infection rate 6.15 %.The levels of CRP, PCT and white blood cell counts were significantly higher in the infection group than in the non-infection group（P 〈0.05）.Totally 164 strains of pathogens were isolated from the 76 ureteral stent tube indwelling patients complicat-ed with febrile urinary tract infections, of which 120 （73.17 %） were gram-negative bacteria, 32 （19.51% ） were gram-positive bacteria, and 12 （7.32%） were fungi.The Escherichia coli and Klebsiella pneumoniae were domi- nant among the gram-negative bacteria; the Enterococcus faecalis and Staphylococcus aureus were the predomi- nant species of gram-positive bacteria.The drug resistance rates of the E.coli and K.pneurnoniae strains to imipen- em, meropenem, piperacillin-tazobactam, cefoperazone-sulbactam and amikacin were low, and the drug resistance rate to cephalosporins was more than 80.00%. The drug resistance rates of the E.faecalis and S.aureus strains to vaneomycin, tigeeycline and linezolid were 0, and the drug resistance rates to penicillin G and oxacillin were more than 90.00 %.CONCLUSION The CRP, PCT and white blood cell counts can be used as routine examination inde- xes for diagnosis and prevention of febrile urinary tract infections in the ureteral stent tube indwelling patients.The gram-negative bacteria are dominant among the pathogen isolated from the ureteral stent tube indwelling pa- tients complicated with febrile urinary tract infections. It is necessary to detect the pathogens in a timely manner and carry out the drug susceptibility testing.