绝经后2型糖尿病患者反复泌尿系统感染病原学及影响因素

Etiological and influencing factors for recurrent urinary tract infections in postmenopausal patients with type 2 diabetes mellitus

目的探究绝经后2型糖尿病(T2DM)患者反复泌尿系统感染的影响因素,并对其病原学特点进行分析。方法选取2019年2月-2021年2月华中科技大学同济医学院附属梨园医院收治的108例绝经后T2DM患者为研究对象,收集患者病历资料,分析患者反复泌尿系统感染病原学特点,单因素及多因素Logistic回归分析患者反复泌尿系统感染的影响因素。结果108例绝经后T2DM患者中,25例患者发生反复泌尿系统感染,感染率为23.15%;尿培养共检出病原菌48株,其中革兰阴性菌30株(62.50%)、革兰阳性菌16株(33.33%)、真菌2株(4.17%),其中主要病原菌为大肠埃希菌,占比39.58%;大肠埃希菌对氨苄西林、头孢唑林、氨苄西林/舒巴坦及环丙沙星的耐药率较高,对头孢哌酮/舒巴坦、庆大霉素、呋喃妥因和哌拉西林/舒巴坦的耐药率较低;多因素Logistic回归分析结果,年龄、绝经年限、T2DM病程、糖化血红蛋白(HbA1c)水平是绝经后T2DM患者反复泌尿系统感染发生的影响因素(P<0.05)。结论革兰阴性菌尤其是大肠埃希菌是引起绝经后T2DM患者反复泌尿系统感染的主要病原菌,年龄、绝经年限、T2DM病程、HbA1c与患者反复泌尿系统感染密切相关。

OBJECTIVE To explore the influencing factors for recurrent urinary tract infection in the postmenopausal patients with type 2 diabetes mellitus(T2DM)and analyze the etiological characteristics.METHODS A total of 108 postmenopausal patients with T2DM who were treated in Liyuan Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology from Feb 2019 to Feb 2021 were recruited as the research subjects,the medical data were collected from the patients,the etiological characteristics of the recurrent urinary tract infection were analyzed.Univariate analysis and multivariate logistic regression analysis were performed for the influencing factors for the recurrent urinary tract infection.RESULTS Among the 108 postmenopausal patients with T2DM,25 had recurrent urinary tract infection,with the infection rate 23.15%.Totally 48 strains of pathogens were isolated from urine specimens,30(62.50%)of which were gram-negative bacteria,16(33.33%)were gram-positive bacteria,and 2(4.17%)were fungi.Escherichia coli was the predominant species of pathogen,accounting for 39.58%.The drug resistance rates of the E.coli strains to ampicillin,cefazolin,ampicillin-sulbactam and ciprofloxacin were relatively high;the drug resistance rates to cefoperazone-sulbactam,gentamicin,nitrofurantoin and piperacillin-sulbactam were relatively low.The result of multivariate logistic regression analysis showed that the age,menopausal years,course of T2DM and glycosylated hemoglobin(HbA1c)were the influencing factors for the recurrent urinary tract infection in the postmenopausal patients with T2DM(P<0.05).CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the postmenopausal T2DM patients with recurrent urinary tract infection.The recurrent urinary tract infection is closely associated with the age,menopausal years,course of T2DM and HbA1c.