2型糖尿病泌尿系统感染病原学特点及影响因素

Etiological characteristics and influencing factors for urinary system infections in patients with type 2 diabetes mellitus

目的分析2型糖尿病(T2DM)患者泌尿系统感染的病原学特点及影响因素。方法选取2017年10月-2019年10月金华市中心医院和宁波市鄞州人民医院的720例T2DM患者作为研究对象,通过查阅病案的方法对其泌尿系统感染情况及影响因素和感染病例尿液病原菌分布及耐药性进行回顾性分析。结果720例T2DM患者102例发生泌尿系统感染,感染率为14.17%。在中段尿样本中共分离102株病原菌,其中,革兰阴性菌85株占83.33%,以大肠埃希菌、肺炎克雷伯菌为主;革兰阳性菌12株占11.76%,以粪肠球菌、金黄色葡萄球菌为主;真菌5株占4.90%,以白假丝酵母为主。革兰阴性菌对氨苄西林、头孢唑林等的耐药率较高,对头孢哌酮/舒巴坦、呋喃妥因、哌拉西林/他唑巴坦等的耐药率较低,革兰阳性菌对青霉素G、氨苄西林等的耐药率较高,对呋喃妥因、替加环素等的耐药率较低。T2DM泌尿系统感染的发生与患者的年龄、糖尿病病程、糖化血红蛋白水平具有相关性(P<0.05)。结论革兰阴性菌是引发T2DM患者泌尿系统感染的主要病原菌,年龄、病程及血糖控制水平均可对其感染风险产生影响。

OBJECTIVE To investigate the etiological characteristics and influencing factors for urinary system infections in the patients with type 2 diabetes mellitus(T2 DM).METHODS A total of 720 patients with T2 DM who were treated in Jinhua Central Hospital and Yinzhou people’s Hospital of Ningbo City from Oct 2017 to Oct 2019 were recruited as the study subjects.The prevalence of urinary system infections,influencing factors,distribution and drug resistance of pathogens isolated from urine specimens of the patients with the infections were retrospectively analyzed.RESULTS Of the 720 patients with T2 DM,102 had urinary system infections,with the infection rate 14.17%.Totally 102 strains of pathogens were isolated from midstream urine specimens,85(83.33%)of which were gram-negative bacteria,12(11.76%)were gram-positive bacteria,and 5(4.90%)were fungi;Escherichia coli and Klebsiella pneumoniae were dominant among the gram-negative bacteria;Enterococcus faecalis and Staphylococcus aureus were the predominant species of the gram-positive bacteria;Candida albicans was dominant among the fungi.The drug resistance rates of the gram-negative bacteria to ampicillin and cefazolin were high,while the drug resistance rates to cefoperazone-sulbactam,furantoin and piperacillin-tazobactam were low.The drug resistance rates of the gram-positive bacteria to penicillin G and ampicillin were high,while the drug resistance rates to furantoin and tigecycline were low.The incidence of urinary system infections in the T2 DM patients was associated with the age,course of diabetes mellitus and level of glycosylated hemoglobin(P<0.05).CONCLUSION The gram-negative bacteria are dominant among the pathogens causing urinary system infections in the T2 DM patients.The age,course of disease and glucose level may affect the risk of the infections.