2型糖尿病患者合并细菌性泌尿系感染的临床特征及致病菌分布

Clinical characteristics and pathogenic bacteria distribution of type 2 diabetes mellitus patients with bacterial urinary tract infection

目的探讨2型糖尿病(T2DM)患者合并细菌性泌尿系感染中多重耐药及非多重耐药的临床特征、致病菌分布与耐药性情况。方法选取2018年1月至2021年4月于渭南市中心医院内分泌科住院的合并泌尿系感染的T2DM患者,根据药敏试验分为多重耐药组及非多重耐药组。比较两组的一般资料,分析泌尿系感染的致病菌与耐药、药敏情况。结果共收集146个病例,培养出150个致病菌株,其中革兰氏阴性菌占89.3%。合并细菌性泌尿系感染的T2DM女性患者数量为男性患者的4.23倍。多重耐药组的神经源性膀胱、入院前2周内抗生素使用史的占比及白细胞计数、中性粒细胞计数、中性粒细胞百分比高于非多重耐药组,血清总蛋白、白蛋白水平明显低于非多重耐药组(P<0.05)。多重耐药菌株中检出的产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌数量明显高于非多重耐药菌株(P<0.05)。在革兰氏阴性菌中,妥布霉素、环丙沙星、庆大霉素、左氧氟沙星、复方新诺明和头孢他啶对非多重耐药菌株的敏感率高于多重耐药菌株,差异超过50%。结论老年女性为T2DM合并细菌性泌尿系感染的高危人群;合并神经源性膀胱、院前使用抗生素、血清白蛋白水平降低、中性粒细胞升高者发生多重耐药菌的泌尿系感染风险较高,致病菌以产EBSLs大肠埃希菌为主,耐药率高。临床应结合患者病情和药敏试验结果选择合适的抗菌药物治疗。

Objective To investigate the clinical characteristics,pathogenic bacteria distribution and drug resistance of multi-drug resistance and non-multi-drug resistance in patients with type 2 diabetes mellitus(T2DM)with bacterial urinary tract infection.Methods T2DM patients with bacterial urinary tract infection who were hospitalized in the endocrinology department of Weinan Central Hospital from January 2018 to April 2021 were selected.According to the drug sensitivity test,the patients were divided into multi-drug resistant group and non-multi-drug resistant group.The general data of the two groups were compared,and the pathogenic bacteria,drug resistance and drug sensitivity of urinary tract infection were analyzed.Results A total of 146 cases were collected and 150 pathogenic strains were cultured,of which Gram-negative bacteria accounted for 89.3%.The number of female patients with T2DM complicated with bacterial urinary tract infections were 4.23 time as many as male patients.The proportions of neurogenic bladder,antibiotic use history within 2 weeks before admission,white blood cell count,neutrophil count and neutrophil percentage in the multidrug resistance group were higher than those in the non-multidrug resistance group,and levels of serum total protein and albumin were significantly lower than those in the non-multidrug resistance group(P<0.05).The number of Escherichia coli producing extended spectrumβ-lactamases(ESBLs)detected in multidrug-resistant strains was significantly higher than that in non-multidrug-resistant strains(P<0.05).Among Gram-negative bacteria,the sensitivity rates of tobramycin,ciprofloxacin,gentamicin,levofloxacin,cotrimoxazole and ceftazidime to non-multidrug-resistant strains were higher than those to multidrug-resistant strains,with a difference of more than 50%.Conclusion Elderly women are at high risk of T2DM complicated with bacterial urinary tract infection.Patients with neurogenic bladder,pre-hospital use of antibiotics,decreased serum albumin and elevated neutrophils have a higher risk of bacterial urinary tract infection with multidrug-resistant bacteria.The pathogenic bacteria are mainly EBSLs-producing Escherichia coli,with high drug resistance rate.Appropriate antimicrobial agents should be selected according to the patients'condition and drug sensitivity test results in clinical practice.