脊髓损伤患者泌尿系感染的病原学特点及耐药性分析

ETIOLOGICAL CHARACTERISTICS AND DRUG RESISTANCE OF URINARY TRACT INFECTION IN PATIENTS WITH SPINAL CORD INJURY

目的探讨脊髓损伤(SCI)患者泌尿系感染(UTI)的病原学特点及耐药情况,并分析不同膀胱排空方式SCI患者UTI病原菌在构成及耐药性方面的差异,为临床治疗提供依据。方法收集2013年1月—2019年12月于我院康复医学科确诊为UTI且尿培养阳性的SCI患者190例作为SCI组,以泌尿外科确诊为UTI且尿培养阳性的非SCI患者630例作为对照组。依据尿培养结果比较两组间病原菌及其对抗菌药物耐药情况的差异;并比较不同膀胱排空方式SCI患者UTI病原菌在构成及耐药性方面的差异。结果SCI组、对照组患者尿液中分别检出病原菌201、669株,大肠埃希菌在两组患者尿液检出的病原菌中构成比最高,分别为66.17%和47.38%,两组比较差异有显著性(χ^(2)=21.842,P<0.05)。留置导尿组、间歇导尿组及无导管排尿组SCI患者尿液中病原菌检出情况比较,差异均无显著性。SCI组大肠埃希菌中超广谱β内酰胺酶(ESBL)阳性率以及对氨苄西林、头孢菌素类和喹诺酮类抗菌药物的耐药率均显著高于对照组(χ^(2)=3.859~49.742,P<0.05)。留置导尿组大肠埃希菌ESBL阳性率以及对氨苄西林、头孢噻肟、头孢唑林的耐药率均显著高于间歇导尿组(χ^(2)=3.898~6.604,P<0.05)。结论SCI患者UTI病原菌中大肠埃希菌构成比、ESBL阳性率及对头孢菌素类和喹诺酮类抗菌药物耐药率较非SCI患者高,SCI患者中留置导尿比间歇导尿更易引起细菌对抗菌药物的耐药,应引起临床重视,谨慎选择抗菌药物。

Objective To investigate the etiological characteristics and drug resistance of urinary tract infection(UTI)in patients with spinal cord injury(SCI),as well as the differences in the composition and drug resistance of UTI pathogens between SCI patients with different bladder-emptying methods,and to provide a basis for clinical treatment.Methods A total of 190 SCI patients who were diagnosed with UTI and had positive urine culture in Department of Rehabilitation Medicine in our hospital from January 2013 to December 2019 were enrolled as SCI group,and 630 non-SCI patients who were diagnosed with UTI and had positive urine culture in Department of Urology were enrolled as control group.According to the urine culture results,the two groups were compared in terms of pathogenic bacteria and their resistance to antibiotics,and the composition and drug resistance of UTI pathogens were compared between SCI patients with different bladder-emptying methods.Results A total of 201 and 669 pathogenic bacteria were detected in the urine of patients in the SCI group and the control group,respectively,and Escherichia coli had the highest composition ratio among the pathogenic bacteria in urine,with a significant difference between the SCI group and the control group(66.17%vs 47.38%,χ^(2)=21.842,P<0.05).There was no significant difference in the detection of pathogenic bacteria in the urine of SCI patients between the indwelling catheterization group,the intermittent catheterization group,and the non-catheterization group.Compared with the control group,the SCI group had significantly higher extended-spectrum beta-lactamase(ESBL)-positive rate of Escherichia coli and drug resistance rates to ampicillin,cephalosporins,and quinolones(χ^(2)=3.859-49.742,P<0.05).Compared with the intermittent catheterization group,the indwelling catheterization group had significantly higher ESBL-positive rate of Escherichia coli and drug resistance rates to ampicillin,cefotaxime,and cefazolin(χ^(2)=3.898-6.604,P<0.05).Conclusion Compared with the non-SCI patients,the SCI patients have significantly higher composition ratio of Escherichia coli,ESBL-positive rate,and drug resistance rates to cephalosporins and quinolones among the pathogenic bacteria of UTI.SCI patients with indwelling catheterization are more likely to develop bacterial resistance to antibiotics than those with intermittent catheterization.This should be taken seriously in clinical practice and antibiotics should be selected with caution.