2型糖尿病合并尿路感染的危险因素及病原学分析

摘要

目的：观察T2DM合并尿路感染病原菌分布特点和药敏结果，并探讨其发生的危险因素。方法分析T2DM 合并尿路感染患者的临床特点及病原学特征。结果 T2DM 合并尿路感染的发生率为6.85％（210／3065），T2DM合并尿路感染组较 T2DM 组年龄大、病程长，FPG ，尿素氮、肌酐及24 h尿白蛋白（24 hUAlb）水平高，白蛋白水平低（P＜0.05）。Logistic回归分析显示，女性、年龄、糖尿病病程、24 hUAlb是发生尿路感染的危险因素，白蛋白为保护因素。分离出的210株病原菌以革兰氏阴性菌为主（84.2％），前3种病原菌为大肠埃希菌（65.2％）、粪肠球菌（6.2％）和肺炎克雷伯菌（5.2％）。革兰氏阴性菌对亚胺培南（100％）、头孢哌酮舒巴坦（99.2％）和阿米卡星（99.2％）敏感性较高，对头孢噻吩（38.1％）、哌拉西林（35.7％）和阿莫西林（28.2％）敏感性较低。结论老年、女性、糖尿病病程长及肾功能不全的T2DM 患者更易发生尿路感染，T2DM合并尿路感染的病原菌仍以革兰氏阴性菌为主，但细菌谱发生了一定的变化，且多重耐药菌呈明显上升趋势。%Objective To explore the risk factors for urinary tract infections in type 2 diabetes mellitus(T2DM )by analyzing the pathogens distribution characteristics and drug sensitivity. Methods A total of 3 ,065 T2DM patients were retrospectively analyzed for the clinical and etiological characteristics of urinary tract infections in T2DM. All patients enrolled in the study were divided into two groups :T2DM with urinary tract infection group (n= 210) and simple T2DM group (n= 132). Data harvested were analyzed by SPSS 19.0. Results Of 3 ,065 patients with T2DM the incidence of urinary tract infection was 6.85%. Compared with T2DM group ,patients in T2DM+ urinary tract infection group were older , with longer duration of diabetes ,higher levels of FPG ,urea nitrogen ,creatinine and 24 hUAlb ,and lower levels of serum albumin ( P< 0.05 ). Logistic regression analysis showed that age ,gender ,duration of diabetes and 24 hUAlb were risk factors and albumin was protective factor for urinary tract infection in T2DM. 84.2% was gram-negative bacteria among the 210 isolated strains of pathogenic bacteria. The top three pathogens were Escherichia coli (65.2% ) ,Enterococcus faecalis (6.2% ) and Klebsiella pneumoniae (5.2% ). Gram-negative bacteria had high sensitivity to Imipenem (100% ) ,Cefoperazone sulbactam (99.2% ) and Amikacin (99.2% ) but low sensitivity to cephalothin (38.1% ) ,piperacillin (35.7% ) and amoxicillin (28.2% ). Conclusion T2DM patients who have the factors including female ,advanced age , long course of diabetes and renal insufficiency are prone to suffer from urinary tract infection. Gram-negative bacteria are the most common pathogens in T 2DM patients with urinary tract infection but bacteria spectrum has changed with percentage of multiple resistant bacteria rising dramatically.