Risk factors of urinary sepsis caused by upper urinary tract infection and characteristics of pathogenic bacteria for this urinary sepsis
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摘要: 目的:探讨上尿路感染致尿脓毒症的相关危险因素以及病原菌的分布和耐药性。方法:2016年5月~2019年5月我院共收治上尿路感染致尿脓毒症患者137例,其中尿培养或血培养阳性者51例。回顾性分析51例患者的临床资料,将合并感染性休克者17例列为重症组,其余34例列为轻症组,采用单因素Logistic回归分析法比较2组的相关危险因素,并总结上尿路感染的病原菌分布及其耐药性。结果:Logistic回归分析显示,上尿路感染致重症尿脓毒症的危险因素有肾积水、上尿路结石、糖尿病、肾功能不全及低蛋白血症(P=0.046,P=0.032,P=0.040,P=0.028,P=0.002),上尿路感染所致的尿脓毒症主要以大肠埃希菌和肺炎克雷伯杆菌为主,革兰阳性菌则以粪肠球菌为主。对革兰阴性菌最敏感的药物依次是美罗培南、厄他培南、亚胺培南、哌拉西林/他唑巴坦、阿米卡星,耐药性最强的依次是氨苄西林、头孢曲松、头孢呋辛;对革兰阳性球菌最敏感的药物依次是万古霉素、利奈唑胺、莫西沙星、氨苄西林,耐药性最强的依次是环丙沙星、左氧氟沙星、青霉素、四环素。结论:肾积水、上尿路结石、糖尿病、肾功能不全及低蛋白血症是上尿路感染致尿脓毒症的危险因素,在治疗上尿路感染所致尿脓毒症时,要积极解决其病因及危险因素,并尽早进行病原菌的检测,合理、规范使用抗菌药物,提高治疗效果,缩短感染进程。Abstract: Objective: The risk factors of urinary sepsis caused by upper urinary tract infection and the distribution and drug tolerance of pathogens are to be explored. Method: From May 2016 to May 2019, 137 patients with urinary sepsis caused by upper urinary tract infection in our department were admitted, and 51 patients of them with positive urine cultures or blood cultures were recruited in this retrospective analysis. Seventeen patients with septic shock were classified as severe group, and other 34 as mild group. The risk factors between the two groups were compared using univariate logistic regression analysis, and the distribution and drug tolerance of pathogenic bacteria in upper urinary tract infection were analyzed and summarized. Result: According to the results of the analysis of logistic regression, the risk factors for severe urinary sepsis caused by upper urinary tract infection include hydronephrosis, upper urinary tract stones, diabetes mellitus, renal insufficiency and hypoproteinemia. Escherichia coli and Klebsiella pneumoniae are the main pathogens, while Enterococcus faecalis is the predominant gram-positive bacteria. The drugs most sensitive to gram-negative bacteria are meropenem, ertapenem, imipenem, piperacillin/tazobactam and amikacin. Ampicillin, ceftriaxone and cefuroxime are three drugs with the strongest drug tolerance successively. The drugs most sensitive to gram-positive cocci are vancomycin, linezolid, moxifloxacin and ampicillin, and the most resistant drugs are ciprofloxacin, levofloxacin, penicillin and tetracycline successively.Conclusion: Hydronephrosis, upper urinary calculi, diabetes mellitus, renal insufficiency and hypoproteinemia are the factors inducing urinary sepsis caused by upper urinary tract infection. When treating patients with urinary sepsis caused by upper urinary tract infection, its causes and risk factors should be actively controlled, and pathogens should be detected as early as possible, the use of antibiotics should be rationally regulated, the therapeutic effect should be enhanced, and the course of infection should be shortened.
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Key words:
- upper urinary tract infection /
- urinary sepsis /
- risk factors /
- pathogens
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