应用增强尿培养对反复下尿路感染女性的尿液微生物特征及抗菌药物疗效分析

Urinary microbiota and effect of antibiotic treatment in female recurrent lower urinary tract infection patients based on enhanced quantitative urine culture

目的 应用增强尿培养(EQUC)分析女性反复下尿路感染(RLUTI)患者的尿液微生物群特征,并评估其作为抗菌药物治疗依据的有效性。方法 纳入2021年6月至2022年8月的RLUTI成年女性患者。收集中段尿进行常规尿培养(SUC)和增强尿培养。SUC阴性但EQUC阳性的患者纳入研究。结果 入组49例患者。共分离出11属30种细菌和1株白念珠菌。其中肠杆菌目、链球菌、葡萄球菌、肠球菌、棒状杆菌和乳酸杆菌分别占36.7%、36.7%、32.7%、26.5%、24.5%和14.3%。31例患者根据EQUC结果接受了抗菌药物治疗。19例(61.3%)治疗后症状缓解。根据细菌种类进行的亚组分析显示,与分离出肠球菌或其他细菌的患者相比,肠杆菌目的患者在治疗后症状缓解的比例更高(13/15,86.7%)(P<0.01)。比较肠杆菌目和肠球菌患者与其他细菌患者之间的抗菌药物治疗效果,前者的症状缓解率显著升高(17/22,77.3%vs. 2/9,22.2%,P<0.05)。结论 应用增强尿培养结果显示:肠杆菌目、肠球菌属、链球菌属、葡萄球菌属和棒状杆菌属是女性RLUTI中的主要分离菌。针对肠杆菌和肠球菌的抗菌药物治疗有助于缓解症状。

Objective To explore the urinary microbiota in female recurrent lower urinary tract infection(RLUTI)patients obtained by enhanced quantitative urine culture(EQUC)and to assess the efficacy of EQUC as a basis for antibiotic treatment of these patients when the standard urine culture(SUC)was negative.Methods Adult female outpatients diagnosed as RLUTI from June 2021 to August 2022 were enrolled.All participants would have urine specimens collected for both EQUC and SUC.Patients with positive results in EQUC but negative in SUC were finally included in the study analysis.Results 49 patients were finally included in the study.Totally 11 genera and 30 species of bacteria and one strain of Candida albicans were isolated.The most prevalent isolated were Enterobacteriaceae,Streptococcus,Staphylococcus,Enterococcus,Corynebacterium and Lactobacillus in 36.7%,36.7%,32.7%,26.5%,24.5%and 14.3%of patients.31 patients received antibiotic therapy based on EQUC results.19 cases(61.3%)reported symptom relief after treatment.In the subtype analysis according to bacterial species,patients with Enterobacteriaceae had a higher rate of symptom relief after treatment(13/15,86.7%)compared with those with Enterococcus or others(P 0.01).Comparing the effect of antibiotic treatment between patients with Enterobacteriaceae and Enterococci,and those with other bacteria,the former group had a much higher rate of symptom relief(17/22,77.3%vs.2/9,22.2%,P 0.05).Conclusion Enterobacteriaceae,Enterococcus,Streptococcus,Staphylococcus and Corynebacterium are the predominant isolates in female RLUTIs revealed by EQUC.Antibiotic treatment targeting Enterobacteriaceae and Enterococcus will help relieve symptoms.