The Analysis About Etiology And Risk Factors In Urinary Tract Infection

Objective: To investigate high risk factors of urinary tract infection,we analyzed the results of urine culture samples and drug resistance of pathogenic bacteria for inpatients in department of urology in our hospital and compared the difference in urine culture positive rate among groups with different risk factor,which provided a reference for the clinical treatment and prevention of patients with urinary tract infection.Methods: We collected the data of urine culture samples of 1100 inpatients in department of urology in Peking University Shenzhen Hospital from January 2017 to December 2017,including the results of urine culture and antimicrobial susceptibility test,age,gender,diseases of urinary system and underlying disease,and patients were grouped according to these aspects.The differences in the incidence of urinary tract infection among different groups were analyzed,and pathogenic bacteria distribution and drug resistance results of patients with urinary tract infection were recorded.Results: A total of 422 strains of pathogenic bacteria were detected,and the detection rate was 38.4%.Of 422 strains of pathogenic bacteria,260 strains were Gram-negative bacilli,accounting for 61.6%,followed by 110 strains of Gram positive cocci for 26.1%,28 strains of fungi for 6.6%,and 24 strains of Gram-positive bacilli for 5.7%.In the cultured Gram-negative bacilli,there were 118 strains of Escherichia coli,accounting for 28% of the total 422 strains,followed by 26 strains of Klebsiella pneumoniae for 6.2% and 22 strains of pseudomonas aeruginosa for 5.2%.In the 118 strains of Escherichia coli,there were 68 strains producing xtended spectrum beta lactamases(ESBLs),exceeding 50% of the total number of Escherichia coli.In the cultured 110 strains of Gram-positive cocci,there were 28 strains of Streptococcus agalactiae and Enterococcus faecalis,respectively,accounting for 6.6% of the total 422 strains,followed by 18 strains of Enterococcus faecium for 4.3%.The cultured fungi included mainly 24 strains of Candida albicans,accounting for 5.7% of the total 422 strains,and 4 strains of candida glabrata.The most potent drugs for Gram-negative bacilli could be basically divided into carbapenems drugs imipenem and meropenem,aminoglycoside drugs amikacin,and beta-lactam compound preparations piperacillin/tazobactam.For Gram-negative bacilli,drugs with the highest drug resistance rate were ampicillin,furadantin and cefuroxime axetil.For the cultured Gram-positive cocci,drugs with the highest sensitivity were vancomycin,teicoplanin,tigecycline,and linezolid,followed by linezolid and penicillin-G.For Gram-positive cocci,drugs with the highest drug resistance rate were tetracycline,erythromycin and clindamycin.Urinary calculi,urologic neoplasms,congenital malformation obstruction of the urinary system,benign prostatic hyperplasia,gender,age,diabetes mellitus might be the risk factors of urinary tract infection.Conclusions: The pathogenic bacteria of urinary tract infection were Gram-negative bacilli,followed by Gram-positive cocci and fungi.The percentage of Gram-negative bacilli decreased,and the percentage of Gram positive cocci increased.Among the cultured Gram-negative bacilli,the proportion of Escherichia coli was the largest.Among the cultured Gram-positive cocci,the proportion of Enterococcus was the majority and the proportion of Streptococcus agalactiae was ascending.For the cultured Gram-negative bacilli,drugs with higher sensitivity were carbapenems drugs imipenem and meropenem,aminoglycoside drugs amikacin,and semi-synthetic penicillin antibiotics/ enzyme inhibition complexing agent piperacillin/ tazobactam.For the cultured Gram-positive cocci,drugs with the highest sensitivity were polypeptide antibiotics vancomycin and teicoplanin,tetracycline antibiotic tigecycline and synthetic antibiotic linezolid.In Escherichia coli,the proportion of the strains producing ESBLs was over 50%,and the drug resistance rate of the strains producing ESBLs was higher than the strains without the production of ESBLs except for carbapenems antibacterial drugs.Urinary calculi,neoplasms,congenital malformation,benign prostatic hyperplasia,advanced age,female,diabetes mellitus might be high risk factors of urinary tract infection.By analyzing the risk factors and etiology of urinary tract infection,this study provided a reference for the clinical treatment and prevention of patients with urinary tract infection.