诊断学理论与实践

诊断学理论与实践 ›› 2019, Vol. 18 ›› Issue (05): 538-542.doi: 10.16150/j.1671-2870.2019.05.010

• 论著 • 上一篇    下一篇

社区老年女性糖尿病患者尿路感染常见病原菌调查

顾勤1, 王泰蓉2(), 陈荔萍1, 吴舒窈1, 沈祎1   

  1. 1.上海市黄浦区打浦桥街道社区卫生服务中心全科医学科,上海 200023
    2.上海交通大学医学院附属瑞金医院卢湾分院老年科,上海 200020
  • 收稿日期:2019-03-06 出版日期:2019-10-25 发布日期:2019-10-25
  • 通讯作者: 王泰蓉 E-mail:shh13621702690@aliyun.com
  • 基金资助:
    上海市黄浦区卫生和计划生育委员会科研基金(HKM201733)

Investigation on common pathogens and related risk factors of urinary tract infection in elderly female diabetic patients in community

GU Qin1, WANG Tairong2(), CHEN Liping1, WU Shuyao1, SHEN Yi1   

  1. 1. General Medicine Department, Dapuqiao Community Health Center, Huangpu District, Shanghai 200023, China
    2. Geriatrics Medical Department, Ruijin Hospital, Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai 200020, China
  • Received:2019-03-06 Online:2019-10-25 Published:2019-10-25
  • Contact: WANG Tairong E-mail:shh13621702690@aliyun.com

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摘要：

目的：调查上海黄浦区打浦桥社区老年女性糖尿病合并尿路感染患者的病原菌分布和耐药情况,探究不同来源和就诊经历患者的病原学信息,为临床治疗提供指导意见。方法：选取214例至本社区卫生服务中心门诊就诊的糖尿病合并尿白细胞阳性的老年女性患者,收集其清洁中段尿标本,进行细菌鉴定及药敏试验。根据患者以往的就诊经历,分为社区组（A组）或综合医院组（B组）,比较2组患者的基本情况、清洁中段尿标本所分离的病原菌构成情况及药敏结果。结果：①214例患者中有166例尿标本培养出病原菌,其中A组94例;B组72例。A组优势病原菌前5位依次为大肠埃希菌、变形杆菌、肺炎克雷伯菌、肠球菌、无乳链球菌和铜绿假单胞菌,B组前5位依次为大肠埃希菌、肺炎克雷伯和阴沟肠杆菌、肠球菌、变形杆菌、洛菲氏不动杆菌;2组均未检出真菌。②对大肠埃希菌耐药率超过50%的药物进行分析,发现A组分别为氨苄西林（77.55%）、左氧氟沙星（58.33%）、环丙沙星（58.00%）;B组分别为头孢呋辛（97.73 %）、氨苄西林（97.62%）、头孢他啶（88.64%）、头孢吡肟（82.93%）、环丙沙星（82.93%）、左氧氟沙星（82.22%）、复方新诺明（51.16%）。③B组青霉素类及其酶抑制剂和二代、三代头孢菌素（包括头孢他定、头孢吡肟、头孢呋辛、头孢西丁）对大肠埃希菌耐药率均显著高于A组（P<0.01）。2组检出的大肠埃希菌均对氨苄西林、环丙沙星、左氧氟沙星耐药,但在耐药率上A组达58%以上,B组达82%以上,2组间差异有统计学意义（P<0.05）。结论：糖尿病老年女性患者合并的尿路感染中,大肠埃希菌是其主要病原菌,但不同就诊经历患者的优势病原菌顺序及耐药情况间存在差异。

关键词: 糖尿病, 社区与医院内尿路感染, 病原菌分布, 耐药状况调查

Abstract:

Objective: To investigate the distribution and drug resistance of pathogens in elderly women with diabetes mellitus complicated with urinary tract infection in Dapuqiao community, Huangpu District, Shanghai, and to study the etio-logical information of patients with different treatment experiences in the region, so as to provide a guidance for clinical treatment. Methods: From June 2016 to June 2018, 214 elderly women with diabetes mellitus and leukocyte positive urine samples were collected for bacterial identification and drug sensitivity test. The patients were divided into community health center group (group A) or general hospital group (group B) according to their previous therapeutic experience whether had been treated in community health center or in general hospital. The basic situation of the two groups and the composition of pathogenic bacteria isolated from clean midstream urine samples were compared and analyzed with the results of drug susceptibility. Results: ① There were 166 patients with pathogenic bacteria, of which 94 were in group A and 72 were in group B. The top five dominant pathogens in group A were Escherichia coli, Proteus, Klebsiella pneumoniae, Enterococcus, Streptococcus agalactiae and Pseudomonas aeruginosa, while the top five pathogens in group B were Escherichia coli, Klebsiella pneumoniae and Enterococcus cloacae, Enterococcus, Proteus and Acinetobacter loffei. No fungus was detected in both groups; ② Drug analysis showed that the drug resistance rate to Escherichia coli exceeded 50%. In group A, the drug resistance was: ampicillin (77.55%), levofloxacin (58.33%) and ciprofloxacin (58.00%); in group B was: cefuroxime (97.73%), ampicillin (97.62%), ceftazidime (88.64%), cefepime (82.93%), ciprofloxacin (82.93%), levo-floxacin (82.22%), compound neomycin (51.16%). ③ The resistance of Escherichia coli to penicillin and its enzyme inhibitors and second generation, third generation, third generation of cephalosporins (including Ceftazidime, Cefepime, Cefuroxime and Cefoxitin) in Group B was significantly higher than that of group A (P<0.01). Both groups were resistant to ampicillin, ciprofloxacin and levofloxacin, but the degree of resistance was 58% in group A and 82% in group B. There was statistically significant difference between the two groups (P<0.05). Conclusions: Escherichia coli is the main pathogen in elderly women with diabetes mellitus complicated with urinary tract infection. However, there are differences in the order of dominant pathogens and drug resistance between patients with different treatment experiences.

Key words: Diabetes mellitus, Urinary tract infection, Distribution of pathogenic bacteria, Survey of drug resistance

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