成人住院患者尿路感染及经验用药调查

目的：调查某院成人住院患者尿路感染及经验用药情况。方法：调取柳州市人民医院2015年1月-2016年12月住院尿培养阳性的成人尿路感染患者，分析不同年龄、性别及危险因素对尿路感染的影响及细菌耐药及经验用药情况。结果：505例住院尿路感染患者，女性（71.49%）、61~90岁（70.30%）所占比例高，其中77例为反复发作性尿路感染患者。糖尿病、尿路梗阻和留置导尿管患者分别占40.59%、35.05%和30.10%。致病菌以大肠埃希氏菌为主（57.28%），ESBL （extended-spectrum β-lactamases，超广谱β-内酰胺酶）阳性率达42.57%，环丙沙星耐药率达56.77%；反复发作性尿路感染检出细菌耐药率更高；84例真菌感染，尿路梗阻和留置导尿管都占67.86%。经验用药中以喹诺酮类（51.68%）、β-内酰胺类/β-内酰胺酶抑制剂（28.12%）和头孢类（14.85%）为主；反复发作患者以喹诺酮类（44.16%）、β-内酰胺类/β-内酰胺酶抑制剂（42.86%）为主。结论：我院住院患者尿路感染以G^-菌为主，耐药率高；控制血糖、尽早拔除导尿管以减低尿路感染的危险因素；经验用药基本符合指南要求，但对反复发作的尿路感染患者，经验用药可减少喹诺酮类的使用。

Status of urinary tract infection and empirical medication in adult inpatients

OBJECTIVE To investigate the status of urinary tract infection and empirical medication in adult inpatients in a hospital. METHODS Urinary tract infection inpatients were investigated whose urine cultures were positive in Liuzhou general Hospital from January to December in 2016. The effect of age, sex and risk factors on urinary tract infection and bacterial drug resistance were analyzed. The empirical medication was also analyzed.RESULTS In 505 patients with urinary tract infection, women and elder patients accounted for 71.49% and 70.30%, respectively. Totally 77 cases had recurrent urinary tract infections (RUTI). Patients with diabetes, urinary tract obstruction and indwelling catheter accounted for 40.59%, 35.05% and 30.10%, respectively. The main pathogenic bacterium was Escherichia coli (57.28%). The rate of Escherichia coli ESBL (+) was 42.57% and levofloxacin resistance rate was 61.76%. The resistance rate of RUTI was higher. In 84 cases of fungal infection, urinary tract obstruction and the use of urinary catheters accounted for 67.86%, respectively. Quinolones (51.68%), beta lactam/beta lactamase inhibitors (28.12%) and cephalosporin (14.85%) were the main empirical drugs. Patients with recurrent seizures were dominated by quinolones (44.16%), beta lactam/beta lactamase inhibitors (42.86%).CONCLUSION G^- bacteria are the main pathogens of urinary tract infection in hospitalized patients in our hospital, with high resistance rates. Controlling blood sugar and removing urinary catheter as early as possible can reduce the risk factors of urinary tract infection. Experimental medication is basically in accordance with the guidelines. However, the experience of repeated episodes of urinary tract infection can reduce the use of quinolones.