菌血症性尿路感染的临床特征及实验指标分析

Analysis of clinical features and experimental indicators of bacteraemic urinary tract infection

目的回顾性分析菌血症性尿路感染(Bacteremic urinary tract infection,BUTI)的临床特征、危险因素和实验指标,为临床早期干预和治疗提供参考。方法回顾性分析2018年1月—2022年12月本院收治的195例尿路感染患者的临床资料,根据血培养结果分为BUTI组(34例)和非BUTI组(161例),比较分析两组的临床特点及实验指标,并应用二元logistic回归分析发生BUTI的危险因素,构建受试者工作曲线(ROC)评价实验指标对BUTI的诊断效能。结果195例尿路感染患者中BUTI发生率为17.42%(34/195),BUTI中以大肠埃希菌最常见89.23%(27/34);产超广谱β-内酰胺酶(ESBLs)阳性率为41.38%(12/29)。尿路感染中老人女性占比多,两组年龄无差异(P>0.05);与非BUTI组相比,BUTI男性患者发病率高,无泌尿系统症状多,入院时体温更高,病程更长,而合并骨质疏松和自身免疫病的比例较低,差异均有统计学意义(P<0.05)。尿亚硝酸酶、外周血白细胞计数、外周血粒淋比值、C反应蛋白和降钙素原均高于非BUTI组,白蛋白低于非BUTI组,差异均有统计学意义(P<0.05);自身免疫病是发生BUTI的危险因素;绘制两组患者ROC曲线显示,外周血粒淋比值、C反应蛋白和降钙素原的AUC分别为0.767、0.840、0.795,三项联合检测对BUTI组AUC大于单项检测,差异有统计学意义(P<0.05)。结论菌血症性尿路感染患者主要病原学以大肠埃希菌为主,外周血粒淋比值、C反应蛋白和降钙素原三项联合检测可提高对BUTI的诊断效能。

Objective To retrospectively analyze the clinical characteristics,risk factors,and experimental indicators of bacterial urinary tract infection(BUTI),and provide reference for early clinical intervention and treatment.Methods Clinical data of 195 patients with urinary tract infections who were admitted to Quanzhou orthopedics hospital from January 2018 to December 2022 were selected as study subjects.They were divided into a BUTI group(34 cases)and a non BUTI group(161 cases)based on blood culture results.The clinical characteristics and laboratory indicators of the two groups were compared and analyzed.Binary logistic regression analysis was used to identify the risk factors for BUTI,and a receiver operating curve(ROC)was constructed to evaluate the diagnostic efficacy of experimental indicators for BUTI.Results The incidence of BUTI in 195 patients with urinary tract infections was 17.42%(34/195),and Escherichia coli being the most common bacteria accounting for 89.23%(27/34);and the positive rate of producing extended-spectrum beta-lactamase(ESBLs)was 41.38%(12/29).The elderly women consist of most of population of the urinary tract infections,however,there was no difference in age between the two groups.Compared with the non BUTI group,the incidence rate of BUTI was higher in male patients,and many of them had no urinary system symptoms;the temperature on admission was higher,and duration of illness was longer,the proportion of patients with osteoporosis and autoimmune diseases was lower in BUTI group;the differences were statistically significant(P<0.05).Urinary nitrite enzyme,white blood cell count,Neutrophil-Lymphocyte ratio,C-reactive protein,and procalcitonin in BUTI group were all higher than those in the non BUTI group,while albumin was lower,with statistical significance(P<0.05).The presence of autoimmune diseases was a risk factor for developing BUTI.The ROC curves of two groups of patients were plotted,and the AUC of Neutrophil-Lymphocyte Ratio,C-reactive protein,and procalcitonin were 0.767,0.840,and 0.795,respectively.The combined testing of the three items showed bigger AUC than that of the single test,and the difference was statistically significant(P<0.05).Conclusions Escherichia coli is the main pathogen in patients with bacteremic urinary tract infection.The combined detection of peripheral blood granulocyte to lymphocyte ratio, C-reactive protein, and procalcitonin has diagnostic value for BUTI.