糖化血红蛋白对2型糖尿病患者尿路感染病原菌的影响

Influence of glycated hemoglobin A1c on pathogens of urinary tract infection in patients with type 2diabetes mellitus

目的 探讨糖化血红蛋白(HbA1c)对2型糖尿病(T2DM)患者尿路感染病原菌的分布和耐药情况是否存在影响。方法 选取2021年9月—2022年9月天津医科大学朱宪彝纪念医院160例尿培养阳性的T2DM住院患者。根据HbA1c检测结果分为A组(5.5%9.0%,76例)。比较2个组尿路感染病原菌的分布和耐药性差异。结果 160例T2DM合并尿路感染患者中共分离出182株病原菌。2个组革兰阴性杆菌检出率均最高(分别为69.38%和64.29%),菌株类型主要为大肠埃希菌(>50.00%)。A组革兰阳性菌和真菌检出率分别为16.33%和14.29%;B组革兰阳性菌和真菌检出率分别为10.71%和25.00%。B组大肠埃希菌对妥布霉素和氨苄西林-舒巴坦的耐药率高于A组(P<0.05);B组多重耐药大肠埃希菌检出率高于A组(P=0.046)。结论 高HbA1c水平T2DM合并尿路感染患者真菌检出率较高;T2DM合并尿路感染患者大肠埃希菌对部分抗菌药物的耐药性随HbA1c水平升高而增加。

Objective To investigate the influence of glycated hemoglobin A1c(HbA1c)on the distribution and drug resistance of pathogens associated with urinary tract infection in patients with type 2 diabetes mellitus(T2DM).Methods From September 2021 to September 2022,160 T2DM inpatients with urine culturing positive were enrolled from Chu Hsien-I Memorial Hospital of Tianjin Medical University.According to the HbA1c determination results,they were classified into group A(5.5%<HbA1c≤9.0%,84 cases)and group B(HbA1c>9.0%,76 cases).The distribution and drug resistance of urinary tract infection pathogens were compared between the 2 groups.Results A total of 182 isolates of pathogens were isolated from 160 T2DM patients with urinary tract infection.The determination rates of Gram-negative bacteria in the 2 groups were the highest(69.38%and 64.29%,respectively),mainly Escherichia coli(>50.00%).The determination rates of Gram-positive bacteria and fungi in group A were 16.33%and 14.29%,respectively.The determination rates of Gram-positive bacteria and fungi in group B were 10.71%and 25.00%,respectively.The drug resistance rate of Escherichia coli in group B to tobramycin and ampicillin-sulbactam was higher than that in group A(P<0.05).The determination rate of multi-drug-resistant Escherichia coli in group B was higher than that in group A(P=0.046).Conclusions The determination rate of fungi in T2DM patients with high HbA1c level and urinary tract infection are high.The drug resistance of Escherichia coli to some antibiotics in T2DM patients with urinary tract infection increases with the increase of HbA1c level.