多重耐药菌相关尿路感染的临床研究

目的通过对多重耐药菌尿路感染的临床特征及其致病菌进行分析研究,以期在对抗生素的选择方面提供依据。方法本研究采用回顾性病例对照研究,对我院2013年3月至2014年3月间14岁以上成年人多重耐药菌尿路感染的临床特征及其致病菌进行分析研究。结果 Logistic回归分析显示:长期留置尿管、尿潴留、肾积水及神经源性膀胱均与多重耐药菌尿路感染的发生相关(OR=2.21,OR=2.77,OR=4.55,OR=1.96,P<0.05)。多重耐药菌尿路感染的致病菌分别是E.coli-ESBL strain、Kleb.pneumoniae-ESBL strain和Staphylococcus aureus(MRSA);主要敏感抗生素是阿米卡星、环丙沙星、庆大霉素、美洛培南、亚胺培南。结论长期留置尿管、尿潴留、肾积水及神经源性膀胱是多重耐药菌尿路感染的易感因素。主要致病菌是E.coli-ESBL strain。

A Case-control Study of Urinary Tract Infection Caused by Multidrug-Resistant Organism

Objective To retrospectively evaluate the relevant factors for urinary tract infection caused by Multidrug-resistant organism（MDRD） and further analysis comprise of bacterial uropathogens, so as to can be used to guide the treatment of urinary tract infection caused by MDRD. Methods The study population comprised 91 eases and 93 controls with urinary tract infection caused by MDRD and non MDRD respectively. Logistic regression analysis was used to detect the relevant factors for urinary tract infection caused by MDRD. Results On univariate analysis, the factors associated with urinary tract infection caused by MDRD were as follows： hydronephrosis（OR 4.57, 95%CI 1.40-14.92, P=-0.001）, permanent urinary catheter（OR 2.61, 95%CI 1.43-4.52, P=-0.002）, urinary retention（OR 3.62, 95%CI 1.79-7.31, P〈0.01）, neurogenic bladder（OR 2.77, 95%CI 1.46-5.23, P=0.001）, antibiotics prior to admission（OR 2.59, 95%CI 1.47-4.51, P=0.001）, purely nephrolithiasis（OR 5.35, 95%CI 1.24-16.79, P=-0.001）. On multivariate analysis, the associations remained significant for permanent urinary catheter （OR 2.19, 95%CI 1.10-4.31, P=-0.022）, urinary retention （OR 2.79, 95%CI 1.30-5.98, P=-0.01）, hydronephrosis （OR 4.53, 95%CI 1.27-16.09, P=0.019） and neurogenic bladder （OR 1.94, 95%CI 1.02-3.67, P=0.037）. Pathogenic bacterium of urinary tract infection caused by MDRD were E.coli-ESBL strain, Kleb.pneurnoniae-ESBL strain and Staphylococcus anreus （MRSA） respectively; the mainly sensitive antibiotics were amikacin, ciprofloxacin, gentamycin, meropenem and imipenem. Conclusion Permanent urinary catheter, urinary retention, bydronephrosis and neurogenic bladder may be predictive factors for urinary tract infection caused by MDRD. High prevalence of multidrug resistance in＇bacterial uropathogens from E.coli-ESBL strain.