妊娠期糖尿病孕妇尿路感染病原菌特征分析

Analysis of pathogenic bacteria characteristics of urinary tract infection in pregnant women with diabetes during pregnancy

目的分析妊娠期糖尿病并发尿路感染患者的临床特征及病原菌分布特点。方法选取我院妇产科接诊的167例妊娠期糖尿病并发尿路感染患者为本次研究对象。收集患者临床资料并采集清洁中段尿进行病原菌鉴定。对分离出的大肠埃希菌进行β-内酰胺酶(ESBLs)检测及药敏试验,采用聚合酶链反应(PCR)检测CTX-M型、TEM型、SHV型基因的携带情况。结果167例妊娠糖尿病合并尿路感染患者,多发生于孕晚期(40.12%,67/167),主要为肾盂肾炎(44.91%,75/167),以尿频、尿急、尿痛单纯尿路刺激症状起病为主(36.50%,50/137)。共检出病原菌167株,其中革兰阴性菌117株(70.06%,117/167),主要为大肠埃希菌,革兰阳性菌41株(24.55%,41/167),主要为粪肠球菌,真菌9株(5.39%,9/167),主要为白色假丝酵母菌。66株大肠埃希菌中,31株为产ESBLs大肠埃希菌(46.97%,31/66),35株为非产ESBLs大肠埃希菌(53.03%,35/66)。产ESBLs大肠埃希菌对氨苄西林、头孢曲松、氨曲南的耐药率为100%,对头孢他啶、环丙沙星、左氧氟沙星、庆大霉素、复方新诺明的耐药率高于50%,分别为51.61%、80.65%、54.84%、61.29%、74.19%,对亚胺培南、哌拉西林/他唑巴坦、阿米卡星的耐药率低于20%,分别为16.13%、0%、6.45%。非产ESBL大肠埃希菌对氨苄西林、氨曲南、环丙沙星的耐药率高于50%,分别为74.29%、57.14%、54.29%,对头孢他啶、头孢吡肟、亚胺培南、哌拉西林/他唑巴坦、阿米卡星的耐药率低于20%,分比为8.57%、5.71%、5.71%、0%、2.86%。18株产ESBLs大肠埃希菌携带一种基因型,其中10株CTX-M型基因扩增阳性,5株TEM型基因扩增阳性,3株SHV型基因扩增阳性。13株携带两种及两种以上基因型,其中7株同时携带CTX-M、TEM型基因,3株同时携带CTX-M、SHV型基因,2株同时携带TEM、SHV型基因,1株同时携带CTX-M、TEM、SHV型基因。结论妊娠期糖尿病合并尿路感染患者多发于孕晚期,以尿频、尿急、尿痛单纯尿路刺激症状起病为主,病原菌主要为大肠埃希菌。产ESBLs大肠埃希菌对临床常见抗菌药物的耐药率高于非产ESBLs大肠埃希菌,产ESBLs大肠埃希菌基因型以CTX-M为主,临床上应重点关注,及时给予干预治疗。

Objective To analyze the clinical characteristics and pathogenic bacteria distribution of pregnant women with diabetes complicated with urinary tract infection.Methods 167 patients with gestational diabetes complicated with urinary tract infection were selected as the subjects of this study.The clinical data were collected from patients and the clean midstream urine was collected for pathogen identification.The ESBLs of the isolated Escherichia coli were detected and the drug sensitivity were test.The carrying status of CTX-M,TEM,and SHV genes were detected by polymerase chain reaction(PCR).Results 167 patients with gestational diabetes complicated with urinary tract infection mostly occurred in the third trimester(40.12%,67/167),mainly pyelonephritis(44.91%,75/167),and the main symptoms were urinary frequency,urgency,and pain caused by simple urinary tract irritation(36.50%,50/137).A total of 167 pathogenic bacteria were detected,including 117 Gram negative bacteria(70.06%,117/167),mainly Escherichia coli,41 Gram positive bacteria(24.55%,41/167),mainly Enterococcus faecalis,and 9 fungal strains(5.39%,9/167),mainly Candida albicans.Among the 66 strains of E.coli,31 strains were ESBLs producing E.coli(46.97%,31/66),and 35 strains were non ESBLs producing E.coli(53.03%,35/66).The resistance rate of ESBLs producing E.coli to ampicillin,ceftriaxone,and aztreonam was 100%,while the resistance rates to ceftazidime,ciprofloxacin,levofloxacin,gentamicin,and compound sulfamethoxazole were over 50%,51.61%,80.65%,54.84%,61.29%,and 74.19%,respectively.The resistance rates to imipenem,piperacillin/tazobactam,and amikacin were less than 20%,16.13%,0%,and 6.45%,respectively.The resistance rates of non ESBLs producing E.coli to ampicillin,aztreonam,and ciprofloxacin were higher than 50%,74.29%,57.14%,and 54.29%,respectively.The resistance rates to ceftazidime,cefepime,imipenem,piperacillin/tazobactam,and amikacin were lower than 20%,with a ratio of 8.57%,5.71%,5.71%,0%,and 2.86%.18 strains of ESBLs producing E.coli carried one genotype,of which 10 strains with positive CTX-M gene amplification,5 strains with positive TEM gene amplification,and 3 strains with positive SHV gene amplification.13 strains carry two or more genotypes,including 7 strains carrying both CTX-M and TEM genes,3 strains carrying both CTX-M and SHV genes,2 strains carrying both TEM and SHV genes,and 1 strain carrying both CTX-M,TEM,and SHV genes.Conclusion The patients with gestational diabetes complicated with urinary tract infection mostly occurred in the third trimester of pregnancy,with the onset of urinary frequency,urgency,pain and simple urinary tract irritation symptoms as the main pathogens,mainly E.coli.The resistance rate of ESBLs producing E.coli to commonly used antibiotics in clinical practice was higher than that of non ESBL producing E.coli.The genotype of ESBLs producing E.coli was mainly CTX-M,and clinical attention should be focused on timely intervention and treatment.