缺血性脑卒中患者并发尿路感染的病原菌分布、临床特点及危险因素

doi:10.3969/j.issn.1006-9771.2024.10.008

摘要/Abstract

摘要：

目的探讨缺血性脑卒中患者发生尿路感染的病原菌分布、临床特点及危险因素。

方法回顾性调查2020年1月至2023年12月期间北京博爱医院634例缺血性脑卒中患者的临床资料，根据是否并发尿路感染分为对照组(n = 551，未并发尿路感染)和观察组(n = 83，并发尿路感染)。统计尿路感染发病率、病原菌分布情况、主要致病菌对不同抗菌药物的耐药情况。比较两组临床特点，采用多因素Logistic回归分析缺血性脑卒中患者发生尿路感染的独立危险因素。

结果缺血性脑卒中患者尿路感染的发生率为13.09% (83/634)。观察组尿液样本中共分离出127株病原菌，其中革兰氏阴性菌80株(62.99%)，革兰氏阳性菌26株(20.47%)，真菌21株(16.54%)。主要革兰氏阴性致病菌为大肠埃希菌和肺炎克雷伯菌，其对第二、三代头孢，复方新诺明和左氧氟沙星等耐药率较高，对碳青霉烯类、β-内酰胺酶抑制剂复方制剂、氨基糖苷类等中等耐药，对替加环素、多黏菌素等高度敏感。主要革兰氏阳性致病菌为屎肠球菌和粪肠球菌，其对红霉素、庆大霉素等耐药率较高，对利奈唑胺、达托霉素、替考拉宁及万古霉素等高度敏感。检出的致病真菌对常用抗真菌药物均无明显耐药。观察组女性、糖尿病、留置导尿管、神经源性膀胱占比高于对照组(χ² > 5.043, P < 0.05)。女性、糖尿病、留置导尿管和神经源性膀胱是缺血性脑卒中患者发生尿路感染的独立危险因素(P < 0.05)。

结论缺血性脑卒中并发尿路感染患者的致病菌以革兰氏阴性菌为主，其次为革兰氏阳性菌和真菌，且革兰氏阴性菌呈多重耐药。女性、糖尿病、留置导尿管和神经源性膀胱是缺血性脑卒中并发尿路感染的独立危险因素。

关键词: 缺血性脑卒中, 尿路感染, 菌群分布, 临床特点, 危险因素

Abstract:

Objective To investigate the pathogenic bacteria distribution, clinical features and risk factors of urinary tract infection in patients with ischemic stroke.

Methods A retrospective study was conducted on 634 patients with ischemic stroke in Beijing Bo'ai Hospital from January, 2020 to December, 2023. They were divided into control group (n = 551, without urinary tract infection) and observation group (n = 83, with urinary tract infection) according to whether they developed urinary tract infection. The incidence of urinary tract infection, the distribution of pathogenic bacteria and the resistance of main pathogenic bacteria to different antibacterial drugs were analyzed. The clinical characteristics of the two groups were compared and analyzed. The independent risk factors of urinary tract infection in patients with ischemic stroke were analyzed with multivariate Logistic regression.

Results A total of 83 cases of 634 patients with ischemic stroke developed urinary tract infection, and incidence was 13.09%. A total of 127 strains of pathogenic bacteria were isolated from the urine samples of the observation group, of which Gram-negative bacteria accounted for 62.99% (80/127), Gram-positive bacteria accounted for 20.47% (26/127) and strains of fungi accounted for 16.54% (21/127). The main Gram-negative pathogens were Escherichia coli and Klebsiella pneumoniae, which were high resistant to second-generation and third-generation cephalosporins, co-trimoxazole, and levofloxacin; moderately resistant to carbapenems, β-lactamase inhibitor compound preparation and aminoglycosides, etc.; and highly sensitive to tigecycline and polymyxin, etc. The main Gram-positive pathogens were Enterococcus faecalis and Enterococcus faecalis, which were a high resistant to erythromycin and gentamicin, and highly sensitive to linezolid, daptomycin, teicoplanin and vancomycin. The pathogenic fungi detected were not obviously resistant to common antifungal drugs. The proportion of female, diabetes, indwelling catheter and neurogenic bladder were significantly higher in the observation group than in the control group (χ² > 5.043, P < 0.05). The female, diabetes, indwelling catheter and neurogenic bladder were independent risk factors for urinary tract infection in patients with ischemic stroke (P < 0.05).

Conclusion The pathogenic bacteria of patients with ischemic stroke with urinary tract infection are mainly Gram-negative bacteria, followed by Gram-positive bacteria and fungi. The Gram-negative bacteria showed multiple drug resistance. Meanwhile, female, diabetes, indentured catheter and neurogenic bladder are the independent risk factors for urinary tract infection.

Key words: ischemic stroke, urinary tract infection, pathogen distribution, clinical features, risk factors

中图分类号:

R743.3

田沛, 范荣富, 王洪岩, 彭明丽. 缺血性脑卒中患者并发尿路感染的病原菌分布、临床特点及危险因素[J]. 《中国康复理论与实践》, 2024, 30(10): 1179-1186.

TIAN Pei, FAN Rongfu, WANG Hongyan, PENG Mingli. Pathogenic bacteria distribution, clinical features and risk factors of urinary tract infection in patients with ischemic stroke[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(10): 1179-1186.

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病原菌种类及名称	菌株数/株	构成比/%
革兰氏阴性菌
大肠埃希菌	29	22.83
肺炎克雷伯菌	28	22.05
鲍曼不动杆菌	8	6.30
铜绿假单胞菌	7	5.51
奇异变形菌	2	1.57
阴沟肠杆菌阴沟亚种	2	1.57
鲁氏不动杆菌	2	1.57
棒状杆菌	2	1.57
革兰氏阳性菌
粪肠球菌	8	6.30
屎肠球菌	8	6.30
凝固酶阴性葡萄球菌	6	4.72
其他革兰氏阳性菌	4	3.15
真菌
白假丝酵母菌	8	6.30
光滑假丝酵母菌	7	5.51
热带假丝酵母菌	4	3.15
其他真菌菌	2	1.57
合计	127	100.00

抗菌药物	大肠埃希菌(n = 29)		肺炎克雷伯菌(n = 28)
抗菌药物	耐药菌株数/株	耐药率/%	耐药菌株数/株	耐药率/%
亚胺培南	2	6.90	8	28.57
厄他培南	2	6.90	6	21.43
美罗培南	0	0.00	3	10.71
头孢呋辛钠/酯	17	58.62	24	85.71
头孢西丁	7	24.14	17	60.71
头孢他啶	12	41.38	28	100.00
头孢吡肟	14	48.28	26	92.86
头孢曲松	17	58.62	24	85.71
头孢哌酮/舒巴坦	2	6.90	21	75.00
哌拉西林/他唑巴坦	2	6.90	20	71.43
阿莫西林/克拉维酸	5	17.24	20	71.43
替卡西林/克拉维酸	0	0.00	4	14.28
氨曲南	5	17.24	4	14.28
左氧氟沙星	14	48.28	27	96.43
环丙沙星	7	24.14	4	14.28
复方新诺明	18	62.07	17	60.71
阿米卡星	4	13.79	9	32.14
妥布霉素	2	6.90	2	7.14
多西环素	4	13.79	1	3.57
米诺环素	0	0.00	1	3.57
替加环素	0	0.00	1	3.57
多黏菌素	1	3.45	0	0.00

变量	对照组 (n = 551)	观察组 (n = 83)	χ²/t值	P值
年龄/岁	63.38±13.56	64.96±11.45	1.009	0.313
病程/d	55.07±21.49	58.92±21.92	1.515	0.130
年龄≥ 60岁/n	353	61	2.830	0.108
女性/n	153	36	8.396	0.005
糖尿病/n	246	48	5.043	0.025
留置导尿管/n	40	36	89.171	< 0.001
神经源性膀胱/n	7	12	38.736	< 0.001
高血压/n	430	63	0.190	0.672
冠心病/n	125	24	1.557	0.266
机械通气/n	19	5	0.702	0.402

变量	B	SE	Wald	P	OR值	95%CI
女性	1.023	0.275	13.816	< 0.001	2.781	1.622~4.770
糖尿病	0.543	0.270	4.050	0.044	1.720	1.014~2.918
留置导尿管	2.257	0.295	58.611	< 0.001	9.552	5.360~17.022
神经源性膀胱	2.369	0.548	18.720	< 0.001	10.686	3.654~31.249