社区泌尿系多重耐药菌感染的危险因素分析

Analysis of risk factors of multi drug resistent organisms infection of urinary system in community

目的 探讨社区泌尿系多重耐药菌(Multi Drug Resistent Organisms,MDROs)感染的危险因素,为临床的诊疗及早期采取防控措施提供依据。方法 采用回顾性调查的方法,以2012年7月至2017年12月收治的539例社区泌尿系细菌感染患者为研究对象,根据药敏结果分为MDROs组(214例)和非MDROs组(325例);采用多因素非条件Logistic回归分析方法分析社区泌尿系感染MDROs的危险因素。结果 单因素分析结果显示,MDROs组和非MDROs组在血常规的白细胞≥10.0×10^9/L、尿常规的亚硝酸盐、使用三代头孢菌素、泌尿系感染史、前一年内的住院史、尿路梗阻性疾病≥3种、贫血、使用免疫抑制剂、尿管留置史、泌尿系统手术等10个因素间的差异有统计学意义(P<0.05);多因素非条件Logistic回归分析结果显示,血常规的白细胞≥10.0×10^9/L(OR=5.068,95%CI1.674~15.344,P=0.004)、使用免疫抑制剂(OR=4.164,95%CI1.265~13.707,P=0.010)、尿路梗阻性疾病≥3种(OR=2.763,95%CI1.276~5.981,P=0.010)、使用三代头孢菌素(OR=2.224,95%CI1.110~4.456,P=0.024)、尿管留置史(OR=2.079,95%CI1.066~4.055,P=0.032)是社区泌尿系MDROs感染的独立危险因素。结论 应严格控制使用抗生素的指征,特别是三代头孢菌素的使用;尽量减少使用免疫抑制剂,减少尿管留置等以降低社区泌尿系MDROs感染的概率,对已具有相应指标的患者,应尽早加强感染防控。

Objective To explore the risk factors of Multi Drug Resistent Organisms(MDROs) infection of urinary system in community,so as to provide basis for clinical diagnosis,treatment and early prevention and control measures. Methods Retrospective investigation was adopted to study 539 patients with MDROs infection of urinary system in community admitted to hospital from July2012 to December2017.All patients were divided into MDROs group(214 cases) and non-MDROs group(325 cases) according to the results of drug sensitivity test.And then,the risk factors of MDROs infection of urinary system in community were analyzed by multivariate unconditional Logistic regression analysis. Results The results of univariate analysis showed that there were statistically significant differences between MDROs group and non-MDROs group in10 factors including white blood cells in blood routine≥10.0×10 9/L,nitrate in urinary routine,use of third generation cephalosporin,history of urinary tract infection,hospitalization history in the previous year,three kinds of urinary tract obstructive diseases or above,anemia,use of immune preparation,indwelling history of catheter and urinary system operation( P <0.05).The results of multivariate unconditional Logistic regression analysis showed that white blood cells in blood routine≥10.0×10 9/L( OR =5.068,95% CI1.674~15.344, P =0.004),use of immune preparation( OR =4.164,95% CI1.265~13.707, P = 0.010 ),more than three kinds of urinary tract obstructive diseases or above( OR =2.763,95% CI 1.276~5.981, P = 0.010 ),use of third generation cephalosporin( OR =2.224,95% CI1.110~4.456, P =0.024) and indwelling history of catheter( OR =2.079,95% CI1.066~4.055, P =0.032) were independent risk factors of MDROs infection of urinary system in community. Conclusion The use of antibiotics,especially the use of third generation cephalosporins,should be strictly controlled.And the use of immunosuppressive agents should be minimized,and indwelling catheter should be reduced as far as possible in order to reduce the probability of MDROs infection of urinary system in community.For patients who already have the corresponding indicators,the prevention and control of infection should be strengthened as soon as possible.