目的:医院获得性尿路感染(UTI)是糖尿病肾病(DN)患者常见的并发症,导致死亡率增加和医疗资源利用率提高。这项研究调查了DN患者的医院获得性UTI,重点关注流行的病原体和耐药性,为临床管理提供信息。
方法:本回顾性研究采用宜都云数据库对2013年1月1日至2022年12月31日青岛大学附属医院收治的141例医院获得性尿路感染患者进行分析。其中,109有DN,32例非糖尿病肾病(NDN)。患者人口统计学,病原体分布,和抗生素耐药性进行了统计评估。
结果:与NDN患者相比,DN患者医院获得性UTI的发生率明显更高(p<0.0001),女性患病率较高(p=0.004)。革兰氏阴性菌,特别是大肠杆菌(E.大肠杆菌)和肺炎克雷伯菌,是DN和NDN患者的主要病原体。大肠杆菌感染在DN组中更常见(p=0.017)。这些病原体表现出对碳青霉烯类抗生素的高度敏感性,β-内酰胺酶抑制剂,阿米卡星,呋喃妥因,和米诺环素;然而,它们对喹诺酮类药物表现出显著的抗性,头孢菌素,还有青霉素.
结论:预防DN患者医院获得性尿路感染至关重要。有效的治疗需要根据病原体抗性谱选择抗菌药物。
OBJECTIVE: Hospital-acquired urinary tract infections (UTIs) are common complications in patients with diabetic nephropathy (DN), leading to increased mortality and increased medical resource utilisation. This study investigated hospital-acquired UTIs in patients with DN, focusing on prevalent pathogens and drug resistance to inform clinical management.
METHODS: This retrospective study analysed 141 patients with hospital-acquired UTIs admitted to The Affiliated Hospital of Qingdao University from January 1, 2013 to December 31, 2022, using the Yidu Cloud database. Among them, 109 had DN, and 32 had nondiabetic nephropathy (NDN). Patient demographics, pathogen distribution, and antibiotic resistance were statistically evaluated.
RESULTS: The incidence of hospital-acquired UTIs was significantly higher in patients with DN compared to those with NDN (p < 0.0001), with a higher prevalence in women (p = 0.004). Gram-negative bacteria, particularly Escherichia coli (E. coli) and Klebsiella pneumoniae, were the primary pathogens in patients with DN and NDN. E. coli infections were more common in the DN group (p = 0.017). These pathogens exhibited high susceptibility to carbapenems, β-lactamase inhibitors, amikacin, nitrofurantoin, and minocycline; However, they showed significant resistance to quinolones, cephalosporin, and penicillins.
CONCLUSIONS: Preventing hospital-acquired UTIs in patients with DN is crucial. Effective treatment requires selecting antibacterial drugs based on pathogen resistance profiles.