气肿性尿路感染的影响因素及预后分析

Influencing factors and prognosis of emphysematous urinary tract infection

目的探讨气肿性尿路感染(emphysematous urinary tract infection,EUTI)的影响因素及预后。方法回顾性分析2013年12月至2020年6月在山东大学齐鲁医院青岛院区诊断为EUTI的患者临床资料,选取同一时间段非气肿性尿路感染患者作为对照组。比较两组患者基线资料的差异。采用二元Logistic回归分析法分析EUTI的影响因素。结果(1)24例EUTI及53例非气肿性尿路感染被纳入本研究。与非气肿性尿路感染相比,EUTI组患者血红蛋白水平较低(t=-5.245,P<0.001),血尿素氮(Z=-4.361,P<0.001)、血清肌酐(Z=-4.543,P<0.001)、血糖(Z=-2.608,P=0.009)及三酰甘油(Z=-2.408,P=0.016)水平均较高,而糖尿病(χ^(2)=13.453,P<0.001)和慢性肾脏病(χ^(2)=17.936,P<0.001)者均较多。血清肌酐升高是尿路感染者发生EUTI的影响因素(OR=1.011,95%CI 1.001~1.020,P=0.025)。(2)大肠埃希菌是24例EUTI患者中最常见的致病菌(14例,58.3%),其他致病菌包括肺炎克雷伯菌(2例,8.3%)、屎肠球菌(1例,4.2%)、泛菌属(1例,4.2%)和混合菌(1例,4.2%)。大肠埃希菌感染的EUTI患者中有10例为超广谱β-内酰胺酶阳性菌。(3)预后不良组(n=4)和预后良好组(n=20)住院天数(Z=-2.457,P=0.014)、休克(P=0.002)、自身免疫疾病(P=0.022)、血白细胞(Z=-2.091,P=0.036)、血尿素氮(t=2.432,P=0.024)的差异均有统计学意义,进一步Logistic回归分析未得出EUTI预后的影响因素。结论血清肌酐升高是尿路感染者发生EUTI的独立影响因素,大肠埃希菌是最常见的致病菌且超广谱β-内酰胺酶阳性菌比例高。

Objective To explore the influencing and prognosis factors of emphysematous urinary tract infection(EUTI).Methods The baseline clinical data of the patients admitted to Shandong University Qilu Hospital(Qingdao)from December 2013 to June 2020 and diagnosed with EUTI were analyzed retrospectively.The patients with non-EUTI(NEUTI)during the same period were selected as the control group.The baseline characteristics between the two groups were compared.Logistic regression analysis method was used to analyze the influencing factors of EUTI.Results(1)24 EUTI patients and 53 NEUTI patients were included in the present study.Compared with the NEUTI group,the hemoglobin level was lower(t=-5.245,P<0.001)and the levels of blood urine nitrogen(Z=-4.361,P<0.001),serum creatinine(Scr,Z=-4.543,P<0.001),blood glucose(Z=-2.608,P=0.009),and triacylglycerol(Z=-2.408,P=0.016)were higher in the EUTI group.The proportions of diabetes mellitus(χ^(2)=13.453,P<0.001)and chronic kidney disease(χ^(2)=17.936,P<0.001)in the EUTI group were higher than those in the NEUTI group.Increasing Scr was the risk factor of EUTI in patients with urinary tract infection(OR=1.011,95%CI 1.001-1.020,P=0.025).(2)Escherichia coli(E.coli,14 cases,58.3%)was the most common causative organism.The other causative organisms included Klebsiella pneumoniae(2 cases,8.3%),Enterococcus faecium(1 case,4.2%),Pantoea(1 case,4.2%),and mixed bacteria of E.coli and Enterococcus faecium(1 case,4.2%).Ten cases of E.coli were extended-spectrumβ-lactamases(ESBL)-positive.(3)Of the 24 patients with EUTI,4 patients had adverse outcomes.The length of stay(Z=-2.457,P=0.014),blood urea nitrogen(t=2.432,P=0.024),shock(P=0.002),autoimmune disease(P=0.022),and white blood cell count(Z=-2.091,P=0.036)were statistically different between good prognosis group(n=20)and poor prognosis group(n=4).However,logistic regression analysis results showed that neither was the influencing factor of poor prognosis of EUTI.Conclusions The elevated Scr level is the independent influencing factor of EUTI among urinary infection patients.E.coli is the most common pathogenic bacteria,and ESBL-positive bacteria are common.