耐碳青霉烯类革兰阴性菌致泌尿系结石患者并发尿源性脓毒血症6例报告及文献复习

Urosepsis caused by carbapenem-resistant gram-negative bacteria infection in patients with urinary calculi:case report and literature review of 6 cases

目的探讨泌尿系结石患者耐碳青霉烯类革兰阴性菌(CRGNB)感染致尿源性脓毒血症的临床特点与治疗策略。方法回顾性分析新疆医科大学第一附属医院收治的6例因CRGNB感染致尿源性脓毒血症的泌尿系结石患者的临床数据,结合近几年国内外治疗该疾病的指南和相关文献重点分析其临床感染特征和临床抗感染用药。结果6例患者均为院内获得性感染,具有输尿管支架管置入史及侵入性操作史,均进行细菌培养实验,并检出CRGNB共7株,采用单药或多药联合的治疗方案,经抗感染治疗均好转。其中病例3、4、6依据药敏试验最小抑制浓度(MIC)值选择用药,疗效良好。结论泌尿系结石患者CRGNB感染致尿源性脓毒血症多发于细菌培养阳性、侵入性操作患者,抗感染治疗有效,需根据患者具体情况和细菌耐药性变化灵活调整用药策略,以达到最佳治疗效果。

Objective To investigate the clinical characteristics and treatment strategies of urosepsis caused by carbapenem-resistant gram-negative bacteria(CRGNB)in patients with urinary calculi.Methods Clinical data of 6 urinary calculi patients with urosepsis due to CRGNB infection treated at our hospital were retrospectively analyzed.The clinical characteristics of infection and anti-infective drugs were analyzed according to the domestic and foreign guidelines and relevant literature.Results All 6 cases were nosocomial infection had a history of ureteral stent tube placement and invasive procedures,and 7 strains of CRGNB were detected with bacterial culture.All patients were improved after anti-infective treatment with single drug or multi-drug schemes.Among them,cases 3,4 and 6 were treated according to the minimum inhibitory concentration(MIC)value of drug sensitivity test,and had good outcomes.Conclusion Urosepsis caused by CRGNB infection in patients with urinary calculi is common in patients with positive bacterial culture and invasive procedures.Anti-infective therapy can flexibly adjust medication strategies according to the specific conditions of patients and changes in bacterial resistance to achieve the best therapeutic effects.