| ObjectivesTo explore the risk factors of urinary tract infection and drug resistance of pathogenic bacteria in patients with primary nephrotic syndrome,and to provide a theoretical basis for clinically reducing the infection rate and improving the cure rate.MethodsEighty patients with primary nephrotic syndrome and urinary tract infection who were hospitalized in the Department of Nephrology of the Fifth Affiliated Hospital of Zhengzhou University from January 2014 to December 2018 were selected as the infection group,and 80 patients with no concurrent urinary tract infection were randomly selected as non-infected group,a total of 160 patients were selected.Collecting age,sex,course of disease,pathological type,comorbidities,treatment plan,hemoglobin,white blood cell count,lymphocyte count,serum albumin,urinary protein quantification,total cholesterol,triglyceride,blood potassium,blood calcium,serum creatinine,immunoglobulin G,immunoglobulin A,immunoglobulin M of the two groups,and infection strains and drug susceptibility tests of the infection group.Analyzing risk factors based on the above clinical data.t-test and χ2 test were used for analysis.Using the above-mentioned meaningful indicators as independent variables,perform binary classification Logistic regression to analyze the independent risk factors of urinary tract infection in patients with nephrotic syndrome.Judging the test efficiency according to work specific curve(ROC)and area under the curve(AUC).Results1.Comparison of infection group and non-infection group,there was no significant difference in age,gender,course of disease,and case type between the two groups(P>0.05),and the two groups are comparable;combined hypertension,combined coronary heart disease,hemoglobin,white blood cell count,total cholesterol,triglycerides,blood creatinine,potassium,calcium,immunoglobulin A And immunoglobulin M were not statistically significant(P>0.05).There were statistically significant differences in serum albumin,combined diabetes,use of glucocorticoids and immunosuppressants,urine protein quantification,immunoglobulin Q and lymphocyte counts(P<0.05).Binary logistic regression analysis showed that combined diabetes,glucocorticoids and immunosuppressive agents,low serum albumin and low immunoglobulin G were independent risk factors for urinary tract infections in patients with primary nephrotic syndrome.Drawing the work specific curve,diabetes,use of glucocorticoids and immunosuppressive agents,immunoglobulin G,and serum albumin area under the curve were respectively 0.57,0.67,0.62,and 0.69,which have better evaluation efficacy.2.Urine culture results of urinary tract infection in 80 adult PNS patients,the results were positive for 73 times,and a total of 76 strains of pathogenic bacteria were cultured.Including 50 strains of gram-negative bacteria,of which E.coli was the most and Klebsiella pneumoniae was the second.Among the 22 strains of gram-postive bacteria,enterococcus was the most.Fungi 4 strains.3.The gram-negative bacteria are more sensitive to imipenem and meropenem,and have the highest resistance rate to oxybenicillin;the gram-positive bacteria has higher sensitivity to teicoplanin,linezolid,Vancomycin and the highest resistance rate to compound neonomine.Conclusions1.Combining diabetes,using glucocorticoids and(or)immunosuppressants,low serum albumin,and low immunoglobulin G are independent risk factors for urinary tract infection in patients with primary nephrotic syndrome.2.The most common pathogenic bacteria that cause urinary tract infection in patients with primary nephrotic syndrome are gram-negative bacteria,mainly Escherichia coli;gram-positive bacteria,mainly Enterococcus;fewer fungi.3.Patients with primary nephrotic syndrome who experience urinary tract infections can be treated empirically with piperacillin and tazobactam.In severe infections,carbapenems,teicoplanin,and linezolid can be used or in combination.And then the therapeutic regimen need to be adjusted according to the drug sensitivity results. |
