无症状菌尿与有症状泌尿道感染患者的临床特点研究

Clinical characteristics of patients with asymptomatic bacteriuria and symptomatic urinary tract infection

目的比较无症状菌尿患者与有症状泌尿道感染者的临床特点,为临床诊断及合理使用抗菌药物提供依据。方法选取2017年1月-12月170例尿微生物培养阳性者为研究对象,分为无症状菌尿组和有症状泌尿道感染组,分析两组患者的科室分布和病原菌种类,感染性指标差异及抗菌药物使用情况等。结果尿路感染在老年人群中高发,大肠埃希菌为主要病原菌;粪肠球菌与奇异变形杆菌在无症状菌尿者中较常见。无症状菌尿者和有症状泌尿道感染者尿白细胞数量(142.00vs.719.25)和脓尿比例(75.6%vs.92.2%)差异有统计学意义(P<0.05)。ROC曲线确定区分无症状菌尿者和有症状泌尿道感染者的尿白细胞cut-off值为357.05。有症状泌尿道感染患者的抗菌药物使用率和使用天数均高于无症状菌尿者(P<0.001)。结论对于尿微生物培养阳性的患者,无法通过科室、人群分布甚至病原体种类区分无症状菌尿和有症状泌尿道感染。尿白细胞数对于临床上无症状菌尿和有症状泌尿道感染的鉴别诊断具有重要价值。对尿微生物培养阳性的无症状菌尿患者,应强化其抗菌药物的合理使用。

OBJECTIVE To compare the clinical characteristics between the patients with asymptomatic bacteriuria（ASB）and patients with symptomatic urinary tract infection so as to provide guidance for clinical diagnosis and reasonable use of antibiotics.METHODS From Jan 2017 to Dec 2017,a total of 170 patients who were positive for microbiological culture were recruited as the study objects and divided into the ASB group and the symptomatic urinary tract infection group.The distribution of patients in departments,species of pathogens,infectious indexes and use of antibiotics were observed and compared between the two groups of patients.RESULTS The urinary tract infection was highly prevalent among the elderly,Escherichia coli was the predominant species of pathogen,Enterococcus faecalis and Proteus mirabilis were common among the patients with ASB.There were significant differences in the white blood cells counts in urine（142.00 vs.719.25）and proportion of pyuria（75.6% vs.92.2%）between the patients with ASB and the patients with symptomatic urinary tract infection（P〈0.05）.The ROC curve showed that the cut-off value of urine white blood cell to distinguish from ASB to symptomatic urinary tract infection was 357.05.The utilization rate of antibiotics of the patients with ASB was higher than that of the patients with symptomatic urinary tract infection,and the time of use of antibiotics of the patients with ASB was longer than that of the patients with symptomatic urinary tract infection（P〈0.001）.CONCLUSION As for the patients who are positive for microbiological culture,it is not possible to distinguish from ASB to symptomatic urinary tract infection through the distribution of departments,populations,or even the species of pathogens.The urine white blood cells counts have significant value in differential diagnosis of ASB and symptomatic urinary tract infection.It is necessary to intensify the reasonable use of antibiotics for the ASB patients with positive microbiological culture.