2型糖尿病合并尿路感染的病原菌分布及药敏分析

目的探讨2型糖尿病患者(T2DM)合并尿路感染(UTI)的病原菌分布和对抗菌药物的耐药情况,指导临床合理应用抗生素。方法对2006年1月～2009年12月在笔者医院内分泌科住院的T2DM合并UTI患者进行病原学鉴定及药敏试验。结果 243例T2DM合并白细胞尿患者经中段尿培养检出162例阳性致病菌,致病菌检出率为66.67%,其中无症状性菌尿占尿路感染的66.05%。致病菌分布中革兰阴性菌株(G-)占59.26%,以大肠杆菌为主,占42.60%;其次为变形菌属,革兰阳性菌株(G+)占34.57%,以肠球菌属为主,占17.28%,而后为缺乳链球菌,真菌感染率为6.17%。药敏试验表明大肠杆菌对氨苄西林、环丙沙星、复方新诺明的耐药率高;肠球菌对复方新诺明、红霉素和环丙沙星的耐药率高;缺乳链球菌对复方新诺明、四环素的耐药明显。结论近年来T2DM合并UTI的病原菌种类中大肠杆菌仍占首位,但比例有所下降,肠球菌属和念珠菌属有明显上升趋势,应高度重视;对传统抗生素耐药性明显,应根据药敏结果合理使用抗生素;建议可对T2DM患者的无症状性菌尿行积极治疗。     

2型糖尿病患者合并尿路感染的病原菌分布和耐药性分析

目的：探讨研究2型糖尿病患者（T2DM）合并尿路感染（UTI）的病原菌分布及其耐药性分析,指导临床合理使用抗生素。方法对2006年1月～2013年10月在笔者医院内分泌科住院的311例T2DM进行病原学鉴定及药敏分析。结果311例T2DM合并白细胞尿患者经中段尿培养分离出335株阳性致病菌,其中无症状性菌尿占尿路感染的69．45％。致病菌分布中革兰阴性菌株（G－）占65．37％,以大肠杆菌为主,占48．96％,其次为变形菌属。革兰阳性菌株（G＋）占25．67％,以肠球菌属为主,占11．94％,其次为无乳链球菌。真菌感染率为8．36％。药敏试验表明大肠杆菌对环丙沙星、氨苄西林、左旋氧氟沙星的耐药率高;变形菌属对复方新诺明、呋喃妥因、氯霉素的耐药率高;肠球菌属对复方新诺明、红霉素、环丙沙星的耐药率高;无乳链球菌对复方新诺明、环丙沙星的耐药率高。结论近年来2型糖尿病合并尿路感染患者中无症状性菌尿占主导地位,其病原菌分布中,大肠杆菌仍占首位,且比例逐年升高趋势,对传统抗生素耐药性明显,应高度重视,根据药敏结果合理使用抗生素。     

2型糖尿病合并尿路感染的病原菌分布及实验室结果

目的分析并探讨2型糖尿病(T2DM)合并尿路感染(URI)的人群特点、病原菌分布及实验室检查指标特征。方法选取2017年2月-2019年2月期间信阳市中心医院收治的476例T2DM合并URI患者和500例单纯T2DM患者进行前瞻性研究。分析T2DM合并URI组患者人群特点、病原菌分布情况、主要致病菌耐药性特点,比较两组实验室生化检查结果。结果 T2DM合并URI患者中,女性患者分布率高于男性患者,年龄≥60岁患者分布率高于年龄60岁患者,临床表现中以无症状菌尿分布率最高;476例T2DM合并URI患者分离出的病原菌中以大肠埃希菌为主(占53.97%),其对亚胺培南耐药率最低;与单纯T2DM组相比,T2DM合并URI组甘油三酯(TG)水平显著较高(P0.05)。结论 T2DM合并URI以女性患者、年龄≥60岁患者为主,临床多表现为无症状菌尿,主要致病菌是大肠埃希菌,高水平TG可能与T2DM合并URI的发生相关。     

89例糖尿病肾病合并尿路感染的病原菌特点及药敏分析

目的探讨糖尿病肾病(diabetic nephropathy,DN)合并尿路感染(urinary tract infection,UTI)的病原菌特点和药敏情况。方法对89例在我院确诊的DN合并尿路感染患者的尿培养、药敏结果进行回顾性分析。结果89例中共培养出97株病原菌,以革兰氏阴性杆菌为主,占79.38%(77/97),革兰氏阳性菌占17.53%(17/97),真菌3.09%(3/97)。致病菌对氨苄青霉素、头孢唑啉、左氧氟沙星、庆大霉素等耐药性明显;革兰氏阴性杆菌对亚胺培南,革兰氏阳性菌对万古霉素耐药率最低。结论DN并UTI的患者病原菌以革兰氏阴性杆菌为主,对传统抗生素耐药性明显,应根据药敏结果合理使用抗生素。     

泌尿系结石合并尿路感染的病原菌种类及药敏特点

目的分析泌尿系结石（UC）合并尿路感染（UTI）的病原菌种类及药敏特点。方法选取2015年1月至2019 年12月在绍兴市中心医院住院治疗的480例UC合并UTI（清洁中段尿培养阳性）患者为研究对象,比较不同临床特征患者病原菌种类,分析主要病原菌对常用抗菌药物的药敏特点。结果尿培养获得革兰阴性杆菌290例,以大肠埃希菌（36.9%）、肺炎克雷伯菌（8.5%）、铜绿假单胞菌（4.0%）、奇异变形杆菌（3.7%）多见;革兰阳性球菌125例（26.0%）,以粪肠球菌（7.1%）、屎肠球菌（6.5%）、无乳链球菌（2.9%）、金黄色葡萄球菌（2.3%）多见;真菌59例（12.3%）,以热带假丝酵母菌（4.1%）、光滑假丝酵母菌（3.1%）、白假丝酵母菌（2.9%）、近平滑假丝酵母菌（0.6%）多见;革兰阳性杆菌6例（1.3%）。不同性别、年龄、血白蛋白、CRP、WBC以及是否存在糖尿病、复发结石、肾功能异常的UC合并UTI患者感染病原菌种类比较,差异均有统计学意义（均P＜0.05）。主要革兰阴性杆菌对碳青霉烯类、含β-内酰胺酶抑制剂类药物敏感率较高,对青霉素类、头孢类药物耐药率较高;主要革兰阳性球菌对利奈唑胺、替加环素、万古霉素敏感率较高,对青霉素、红霉素、克林霉素耐药率较高。结论UC 合并UTI患者感染病原菌以革兰阴性杆菌为主,其中大肠埃希菌是最常见病原菌。不同临床特征患者病原菌种类有所差异,应根据细菌培养及药敏试验结果选择合理的抗菌药物,以改善患者病情,提高疗效。     

2型糖尿病合并肾周围炎的病原菌分布及其危险因素分析

目的分析2型糖尿病合并肾周围炎的病原菌分布情况及危险因素。方法选取在本院就诊的2型糖尿病合并肾周围炎患者为合并肾周围炎组,2型糖尿病合并单纯尿路感染患者为尿路感染组；2型糖尿病不合并泌尿系感染患者为2型糖尿病组。对3组患者的全血、尿液、痰液进行病原菌培养及鉴定,并检测相关指标。结果合并肾周围炎组患者空腹血糖、餐后2 h血糖、C反应蛋白(CRP)、24 h尿蛋白定量水平均较高,糖化血红蛋白(HbAlc)水平较低；HbAlc、尿微量白蛋白、24 h尿蛋白定量是影响2型糖尿病患者合并肾周围炎的独立危险因素(P＜0.05)。结论在2型糖尿病合并肾周围炎患者的全血、尿液、痰液中病原菌以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌为主。HbAlc、尿微量白蛋白、24 h尿蛋白定量为2型糖尿病患者合并肾周围炎的重要危险因素。     

糖尿病合并尿路感染315例病原菌及耐药分析

目的 了解糖尿病患者合并尿路感染的常见病原菌分布及其对抗菌药物的耐药情况,指导临床合理使用抗菌药物.方法 回顾性分析医院315例糖尿病患者合并尿路感染的中段尿培养及药敏试验结果.结果 糖尿病患者合并尿路感染最常见的致病菌是革兰阴性菌,其中以大肠埃希菌占首位,对碳青酶烯类抗菌药物耐药率低,对氨苄青霉素、喹诺酮类抗生素耐药率较高;革兰阳性球菌中以肠球菌、凝固酶阴性葡萄球菌多见,对万古霉素、利奈唑胺100％敏感,对其他抗菌药物均有不同程度的耐药;尿路真菌感染比例较高.结论 糖尿病患者尿路感染病原菌耐药形式严重,二重感染增加,应引起重视,尽量根据细菌药敏试验结果选择抗菌药物.     

糖尿病合并尿路感染72例临床分析

①目的探讨糖尿病合并尿路感染（UTI）的相关因素、临床特点。方法对72例糖尿病合并尿路感染患者进行回顾性分析。结果糖尿病合并尿路感染的发生率为5.4%,大多数是无症状的尿路感染,占72.3%,其中男性患者发生率为2.5%,女性患者发生率为7.5%,女性发生率显著高于男性（P〈0.05）。60岁以上者占79.8%;并发尿路感染者血糖水平控制较差;清洁中段尿培养多为革兰氏阴性菌,占65.3%。糖尿病病程及并发症与UTI关系不显著。结论糖尿病患者发生尿路感染的原因是多方面的,老年女性糖尿病患者更易发生UTI。     

儿童糖尿病合并尿路感染的细菌谱及药敏分析

目的:探讨儿童糖尿病合并尿路感染的细菌谱及药敏情况,为临床使用抗生素提供依据.方法:对255例2型糖尿病合并尿路感染的患儿进行中段尿细菌培养及药敏试验.结果:255份标本中有198例培养出致病菌,阳性率为77.65%;主要致病菌以肠杆菌科、葡萄球菌属和非发酵菌为主;药敏结果以亚胺培南、洛美沙星和诺氟沙星敏感性为最高.结论:引起糖尿病患儿尿路感染的致病菌以肠杆菌科、葡萄球菌属和非发酵菌为主要致病菌.治疗应以亚胺培南、洛美沙星和诺氟沙星为主;庆大霉素、呋喃妥因、复方新诺明、青霉素和哌拉西林由于敏感性太低应慎用.     

97例2型糖尿病伴尿路感染的细菌及药敏分析

目的：分析2型糖尿病伴尿路感染常见细菌及药敏结果,以指导临床合理选择抗生素。方法：选择糖尿病患者和非糖尿病伴尿路感染患者进行等分组,取患者的中段尿进行培养、细菌鉴定及药敏试验。结果：2型糖尿病伴尿路感染的致病菌主要为大肠埃希菌,并且感染的菌种存在多样性,且具有多重耐药性。结论：糖尿病伴尿路感染患者应根据药敏试验结果合理使用抗生素。     

糖尿病和非糖尿病患者尿路感染的比较

目的 探讨糖尿病患者的尿路感染特点。方法 选择179例住院的尿病原学阳性的尿感患者。据有无糖尿病分成两组，对其临床资料、病原体的分布及两种主要病原菌大肠埃希菌和肠球菌的药敏结果进行对照。结果 糖尿病患者无症状菌尿的发生率较高，对治疗的反应性较差，并且易于发生多重致病菌的感染，在医院感染中真菌的感染机会较多。在对各种抗生素的耐药方面，两组患者差异无显著意义。结论 要重视糖尿病患者尿病原体的培养，治疗过程中可能需要抗生素的联合运用和抗真菌药物的使用。     

老年泌尿道感染诊治进展

泌尿道感染（UTI）指尿路上皮对病原菌侵入导致的炎性反应,常伴有细菌尿和脓尿。老年UTI广义上分为症状性细菌尿、无症状性菌尿（ASB）。老年UTI常缺乏典型的症状及体征,需要结合实验室检查、病原学检查、药敏试验等进行诊断和指导治疗,积极有效的预防、鉴别不典型的临床表现、明确诊断、合理使用抗生素是老年UTI的治疗关键。本文对老年UTI的流行病学和病原学以及诊治、预防的进展进行综述,以期为广大医生提供参考,最终提高老年UTI治疗效果和老年人生活质量。     

糖尿病患者尿路感染的临床和细菌学特征(附86例报告)

８６例糖尿病患者真性菌尿的阳性率６５．１２％，有临床症状者仅占１７．８６％，致病菌中革兰氏阴性杆菌占６１．６７％，其中以大肠杆菌最常见，革兰氏阳性球菌占３３．３３％，其中以金黄色葡萄球菌最多见。病原菌对常用抗生素的耐药率多在５０％以上，且存在多重耐药现象，因此建议对糖尿病患者常规做尿培养，并依据药敏试验选择抗生素。     

泌尿系感染病原菌的分布及抗菌素耐药性分析

目的为了探讨泌尿系感染病原菌的种类及其耐药性。方法用普通培养法检测706例泌尿系感染患者的新鲜中段尿标本，K-B法进行药敏试验。结果706例受检标本分离出致病菌476株，主要菌群有大肠杆菌、粪肠球菌以及葡萄球菌、克雷伯杆菌、变形杆菌等。除11株真菌外，其余465株致病菌对氨苄青霉素和青霉素的耐药率最高，分别达70％和76％；亚氨培南、万古霉素最低分别为2％和0％，其次是丁氨卡那为10％。结论泌尿系感染病原菌的耐药性监测，对指导临床治疗具有重要意义。     

Evaluation of the Nitrite Test in Screening for Urinary Tract Infection in Febrile Children with Sickle Cell Anaemia in Maiduguri- Nigeria

BACKGROUND: Urinary tract infection is a significant cause of morbidity in children with sickle cell anaemia (SCA). Individuals with SCA have increased risk of urinary tract infection (UTI). Facilities for urine culture may not be available in most rural and even some urban areas in most developing countries like Nigeria. It will therefore be useful to have a simple means of screening such children for UTI with the intent of prompt treatment. MATERIALS AND METHODS: The study will evaluate the usefulness of the nitrite test in detecting UTI in febrile SCA children. This study was carried out in the Department of Paediatrics University of Maiduguri Teaching Hospital and State Specialist Hospital Maiduguri. RESULTS: The study consisted of 250 children aged 6 months to 15 years with SCA presenting with fever (temperature ≥ 37. 5°C). Midstream urine specimen was collected from older children and suprapubic bladder aspiration of urine specimen was collected from infants. Samples were subjected to nitrite test, culture and sensitivity. There was significant bacteriuria in 65 (26+) children with SCA. A positive test for nitrite was obtained in 43 of the 65 (66.2+) children. The nitrite test has a specificity of 93.5+ in detecting bacteriuria, a sensitivity of 66.2+, a positive predictive value of 78.2+ and a negative predictive value of 93.5+. A positive nitrite test was significantly associated with bacteriuria, while a negative test was also significantly associated with an absence of bacteriuria. CONCLUSIONS: From this study, the nitrite test is useful as a screening test for UTI in SCA children. However in sick children with SCA, microscopy, culture and sensitivity should still be done in spite of a negative nitrite test.     

A Comparative Study of the Triphenyltetrazolium Chloride (Uroscreen) Test and Conventional Methods for the Detection of Bacteriuria

Acute urinary tract infection may be preceded by and active pyelonephritis may be associated with asymptomatic bacteriuria. Treatment of asymptomatic bacteriuria may prevent or arrest active, chronic pyelonephritis and its sequelae. Consequently, there is a need for a reliable and simple screening procedure to detect asymptomatic bacteriuria in large segments of the population.

The reliability and practicability of tests advocated for the detection of bacteriuria, including the new chemical triphenyltetrazolium chloride (T.T.C.) (Uroscreen) test, were evaluated. Reliability was assessed by correlating results of these tests with bacterial counts of tested urines. Significant bacteriuria is defined as the presence of 100,000 or more organisms per ml. of urine.

The T.T.C. (Uroscreen) test was positive in 92.5% of cases of bacteriuria; there were 7.5% false-negative and 2.8% false-positive results. Bacteria on Gram-stained smear were found in 95.5% of the cases of bacteriuria and in 14.6% of those with non-infected urine; pyuria (more than three leukocytes per high-power field), in 60% of those with bacteriuria and in 15.9% of those with presumably non-infected urine. Bacteria were conspicuous in the urinary sediment in 91.1% of cases of bacteriuria and in 3.7% of presumably non-infected urines.

The T.T.C. (Uroscreen) test fulfilled the criteria for a reliable and simple screening procedure. It should be used concomitantly with other screening tests when the urine is examined routinely.

     

Asymptomatic bacteriuria and inflammatory response to urinary tract infection of elderly ambulatory women in nursing homes

BACKGROUND: Bacteriuria > or = 10(5) CFU/ml is evidence of urinary tract infection in the absence of associated signs or symptoms. The presence of pyuria with asymptomatic bacteriuria established the response of elderly women against microorganisms capable of causing invasiveness or tissue injury of the urinary tract. METHODS: The association between bacteriuria and pyuria was determined in 178 elderly, ambulatory women without symptoms of urinary tract infection in seven nursing homes. Urine culture results were subsequently analyzed in conjunction with absolute leukocyte count in urine. In this cross-sectional study, asymptomatic bacteriuria in elderly women was classified with and without pyuria. RESULTS: The prevalence of asymptomatic bacteriuria was found in 44 (24.7%) elderly women. The presence of pyuria had a sensitivity of 63.6% for bacteriuria and a specificity of 91%. The positive predictive value for the presence of pyuria predicting those with bacteriuria was 70%, and the negative predictive value for the absence of pyuria predicting those without bacteriuria was 88.4%. Escherichia coli was the most common organism isolated in 81.8% of the women. CONCLUSIONS: Bacteriuria > or 10(5) CFU/ml associated with pyuria was detected in 77% of elderly women with asymptomatic urinary tract infections. Bacteriuria of < 10(5) CFU/ml with pyuria proves less sensitive as an indicator of urinary tract infection. Elderly women with pyuria but without bacteriuria should be studied for other causes of urinary tract inflammation.     

Prevalence of asymptomatic bacteriuria in school going children in Pokhara valley

Objectives: There were mainly two objectives of the study. One was to detect bacteriuria in school going children in Pokhara valley and the other was to identify the causative organisms in various age groups in children. Materials and methods: This study was carried out in the Microbiology laboratory of The School of Pharmaceutical and Biomedical Sciences, Simalchaur, Pokhara University, Nepal. A total of 502 urine samples of 5 to 13 years children from different schools of Pokhara valley were screened to see asymptomatic bacteriuria during January 2005 to June 2005. A sterile wide mouth container was given to each student to collect mid-stream urine samples. All the urine samples were transported to the Microbiology laboratory within half an hour to one hour. The samples were processed for microscopical examination to observe for turbidity and the presence of protein and sugar by dipstick method, microscopical examination to see pus cells, RBCs, epithelial cells, casts and crystals, culture of urine samples on Blood agar and MacConkey agar to identify the potential pathogens. The antibiotic sensitivity test was performed for those bacteria which were grown on culture. The colony count was evaluated and organisms were identified by biochemical tests. Result: Out of 502 samples, 7(1.39%) samples grew the bacterial pathogens that are responsible to cause urinary tract infection. Among them Escherichia coli 4(57.14%) was the predominant bacterial pathogen. Conclusion: Study of asymptomatic bacteriuria is important as found in the present study in which Escherichia coli was the most frequently incriminated as the causative agents. Key words: Asymptomatic bacteriuria, Escherichia coli, children.     

2型糖尿病合并肺部感染病原菌分布及药物敏感性

目的探讨糖尿病合并肺部感染患者的病原菌分布及药物敏感性。方法回顾性分析2008-03/2011-10月作者医院67例2型糖尿病合并肺部感染患者的痰培养,统计其病原菌分布特点和药物敏感性结果。结果 67例2型糖尿病合并肺部感染患者共检出病原菌58株,检出率为86.6%。其中革兰阴性（G-）菌株37株,占63.8%;G＋菌19株,占32.8%;真菌2株,占3.4%。G-菌对亚胺培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、阿米卡星敏感率在86.5%～100%;对头孢他啶、头孢噻肟、头孢吡肟的敏感率在27.3%～74.9%之间;革兰阳性（G＋）菌对万古霉素敏感率为100%,对替考拉宁和哌拉西林/舒巴坦敏感率均在90%以上。结论糖尿病合并肺部感染的病原菌主要为G-杆菌,应引起临床重视。     

相差显微镜检查尿沉渣上皮细胞黏附细菌对老年女性尿路感染的诊断意义

目的探讨用相差显微镜检查尿沉渣中黏附细菌的上皮细胞对尿路感染的诊断意义。方法对55例年龄60～85岁、平均年龄(68.98±6.08)岁、反复发生尿路感染的老年女性患者进行尿沉渣相差显微镜检查共150例次,对部分患者尿标本进行沉渣涂片染色与相差镜检比较,同时进行尿常规以及尿细菌培养计数检查。比较治疗前后上述检查结果的变化,分析应用相差显微镜检出的附菌上皮细胞在诊断老年女性尿路感染中的意义。结果尿相差显微镜检查附菌上皮细胞是诊治女性、特别是老年女性尿路感染的特异性指标,与尿培养细菌计数结果成正相关(r=0.8888,P<0.05)。单独尿沉渣相差显微镜检查附菌上皮细胞诊断老年女性尿路感染的特异性为84.8%,单独尿常规白细胞计数的特异性为51.9%。结论尿相显微镜检查附菌上皮细胞是诊断尿路感染比较特异、敏感和简便易行的方法。