上下尿路梗阻的病原菌检验情况及其耐药性、相关因素logistic分析

Detection of pathogenic bacteria in upper and lower urinary tract obstruction and logistic analysis of drug resistance and related factors

目的探讨上下尿路梗阻患者病原菌分布及耐药性情况,并分析影响患者病原菌感染的影响因素。方法选取2016年5月至2019年4月在本院收治的200例上下尿路梗阻患者作为研究对象,统计患者临床资料,并检测是否出现病原菌感染,分析病原菌分布、耐药菌情况,采用logistic回归分析上下尿路梗阻患者病原菌感染影响因素。结果共79例患者出现感染,其中革兰氏阴性菌感染患者61例,革兰氏阳性菌感染16例,真菌感染2例;大肠埃希菌对头孢吡肟、氨苄西林、阿米卡星、氨曲南及哌拉西林的耐药率不低于50%,奇异变形杆菌对环丙沙星及甲氧苄氨嘧啶的耐药率不低于50%,肺炎克雷伯菌对氨苄西林、环丙沙星及甲氧苄氨嘧啶的耐药率不低于50%;粪肠球菌对四环素、青霉素、左氧氟沙星、红霉素及环丙沙星的耐药率不低于50%,表皮葡萄球菌对四环素、红霉素、环丙沙星、氨苄西林、青霉素、苯唑西林及甲氧苄氨嘧啶的耐药率不低于50%,屎肠球菌对四环素、左氧氟沙星、红霉素、环丙沙星、利福平、氨苄西林及青霉素的耐药率不低于50%;年龄、住院时间、糖尿病、泌尿科器械检查、留置尿管、膀胱冲洗及膀胱输尿管逆流均是影响上下尿路梗阻患者出现病原菌感染的独立性影响因素(P<0.05)。结论上下尿路梗阻患者年龄、住院时间、糖尿病、尿潴留、留置尿管、膀胱冲洗及膀胱输尿管逆流均是影响患者出现病原菌感染的独立性影响因素,其中革兰氏阴性菌是导致上下尿路梗阻患者主要的病原菌感染类型并具有较强的耐药性。

Objective To investigate the distribution and drug resistance of pathogenic bacteria in patients with upper and lower urinary tract obstruction,and to analyze the influencing factors of pathogenic bacterial infection.Methods From May 2016 to April 2019,200 patients with upper and lower urinary tract obstruction admitted to our hospital were selected as the research objects.The clinical data of the patients were collected and the pathogenic bacteria infection was detected.The distribution of pathogenic bacteria and drug-resistant bacteria were analyzed.The influencing factors of pathogenic bacteria infection in upper and lower urinary tract obstruction patients were analyzed by logistic regression.Results Seventy-nine cases of upper and lower urinary tract obstruction were infected,including 61 cases of gram-negative bacterial infection,16 cases of gram-positive bacterial infection and 2 cases of fungal infection.The resistance rate of escherichia coli to cefepime,ampicillin,etimicin,aztreonam and piperacillin was no less than 50%,and the resistance rate of proteus mirabilis to ciprofloxacin and trimethoprim was no less than 50%.The resistance rate of klebsiella pneumoniae to ampicillin,ciprofloxacin and trimethoprim was not less than 50%.The resistance rate of enterococcus faecalis to tetracycline,streptomycin,levofloxacin,erythromycin,chloramphenicol and ciprofloxacin was not less than 50%.Staphylococcus epidermidis to tetracycline,erythromycin,ciprofloxacin,ampicillin,penicillin G,imipenem,cefazolin and oxacil was not less than 50%.The resistance rates of E.faecium to tetracycline,streptomycin,levofloxacin,erythromycin,ciprofloxacin,rifampicin,ampicillin and penicillin G were not less than 50%.Age,length of stay,diabetes mellitus,urinary apparatus examination,indwelling catheter,bladder irrigation and bladder-ureter reflux were all factors affecting the occurrence of upper and lower urinary tract obstruction.Independent influencing factors of protozoa infection(P<0.05).Conclusions Age,hospitalization time,diabetes mellitus,urinary instrument examination,indwelling ureter,bladder irrigation and bladder-ureter reflux are all independent influencing factors of pathogenic bacteria infection in patients with upper and lower urinary tract obstruction.Gram-negative bacteria are the main type of pathogenic bacteria infection in patients with upper and lower urinary tract obstruction and have strong drug resistance.