留置尿管患者泌尿道多重耐药菌的分离及危险因素

Isolation of multi-drug resistant bacteria strains from the urinary tract and identification of its risk factors in patients with indwelling catheters

目的分析住院留置尿管患者的泌尿道多重耐药菌株分离情况及相关危险因素,为防控泌尿道多重耐药菌提供科学依据。方法收集2017年1月至2018年12月某综合医院住院留置尿管患者资料,根据纳入和排除标准筛选研究对象,从临床实验室获取患者的泌尿道菌株及多重耐药菌的分离情况,单因素分析多重耐药菌株分离的影响因素,建立Logistic回归模型分析泌尿道多重耐药菌株分离与危险因素的关系,并分层分析相关高危因素。结果住院留置尿管患者的泌尿道多重耐药菌分离率为17.57%(26株),其中留置尿管≥7 d患者分离出革兰阴性多重耐药菌22株(86.42%)。单因素分析显示,性别、糖尿病、入住过ICU、二联抗生素应用和三联抗生素应用与留置尿管患者泌尿道多重耐药菌的分离有关(P均<0.05)。Logistic回归分析结果显示,糖尿病(OR=3.48)、入住过ICU(OR=3.80)和三联抗生素应用(OR=4.32)是多重耐药菌分离的独立危险因素。分层分析显示,入住过ICU的患者三联抗生素应用与多重耐药菌的分离明显相关(P<0.001),并且随着三联抗生素应用天数的增加,多重耐药菌分离率随之升高(P-trend<0.001)。结论糖尿病、入住ICU和三联抗生素应用是留置尿管患者泌尿道多重耐药菌分离的独立危险因素。入住过ICU的留置尿管患者的三联抗生素应用与泌尿道多重耐药菌分离显著相关,分离率随着应用天数的增加而逐渐升高。临床医师宜针对以上危险因素采取预防控制措施。

Objective To isolate multi-drug resistant bacterial strains from the urinary tract of hospitalized patients with indwelling catheters at a general hospital and identify its risk factors,in order to provide a scientific basis for the prevention and control of multi-drug resistant bacteria in the urinary tract.Methods The data of hospitalized patients with indwelling catheters from January 2017 to December 2018 was collected at a general hospital,and the study subjects were screened according to the inclusion and exclusion criteria.The data of the bacteria and multi-drug resistant bacteria from the patients were acquired from the clinical laboratory,and the relationship between influencing factors and the isolation of multi-drug resistant bacteria was analyzed via univariate analysis.A logistic regression model was established to analyze the relationship between the isolation of multi-drug resistant bacteria from the urinary tract and the risk factors,and the relevant high-risk factors was analyzed by stratified analysis method.Results The isolation rate of multi-drug resistant bacteria in all strains was 17.57%(26 strains).Among the patients with indwelling catheters≥7 days,22(86.42%)strains of Gram-negative multi-drug resistant bacteria were isolated.Univariate analysis showed that gender,diabetes,admission to ICU,and application of dual and triple antibiotics were related to the isolation of multidrug-resistant bacteria from the urinary tract of patients with indwelling catheters(P<0.05).Logistic regression analysis showed that diabetes(OR=3.48),admission to ICU(OR=3.80)and application of triple antibiotics(OR=4.32)were independent risk factors for the isolation of multi-drug resistant bacteria.Stratification analysis showed that the application of triple antibiotics was significantly related to the isolation of multi-drug resistant bacteria(P<0.001),and with the increasing exposure days of the application of triple antibiotics,the isolation rate of multi-drug resistant bacteria increased(Ptrend<0.001).Conclusion Diabetes,admission to ICU,and application of triple antibiotics are independent risk factors for the isolation of multidrug-resistant bacteria from the urinary tract of patients with indwelling catheters.The application of triple antibiotics in patients with indwelling catheters who have been admitted to the ICU is significantly related to the isolation of multidrug-resistant bacteria from the urinary tract,and with the increasing in the exposure days of the application of triple antibiotics,the isolation rate gradually increases.Clinicians should take some preventive and control measures against the above risk factors.