| Objective To explore the risk factors and pathogen distribution of urinary tract infection(UTI)in continuous ambulatory peritoneal dialysis(CAPD)patients by collecting urine culture and drug sensitivity results and general clinical data of CAPD patients with UTI.To provide basis of antibiotic selection and prevent risk factors of UTI from CAPD patients.Methods The infection group consisted of 90 CAPD patients with UTI who were admitted to the Department of Nephropathy,First Affiliated Hospital of Anhui Medical University from June 2015 to June 2020.The control group consisted of 32 CAPD patients without UTI.The clean urine of the patient was collected after admission and sent to the laboratory for bacterial culture.The clinical data of all patients were collected for statistical analysis.Results(1)From the urine culture of 90 CAPD patients with UTI,90 strains of bacteria were identified.Gram-negative bacteria constituted an important part of the total number of bacteria,with a ratio of 3:2 to Gram-positive bacteria.(2)The number of cases of Enterococcus faecalis was the largest in the gram-positive bacteria.There was a certain degree of resistance to 5 antibiotics at least.Enterococcus faecium was in second place,whose drug resistance spectrum and resistance to various antibiotics were higher than the former.Vancomycin was effective against all bacteria.The proportion of Methicillin-Resistant Staphylococcus Aureus among gram-positive bacteria was 13.3%.(3)Escherichia coli was the highest proportion bacteria among gram-negative bacteria.It has a resistance rate of 76.67% to ampicillin.It was only sensitive to some powerful antibiotics.Most antibiotics were not effective against it.Klebsiella pneumoniae was100% resistant to ampicillin,but its resistance spectrum was not wide.There were 14ESBL-producing strains in Escherichia coli,and the proportion was close to half of the total number of Escherichia coli.(4)The patients with urinary tract structural changes in infection group(71.1%)was more than that in the control group(46.8%)(χ2 =6.076,P<0.05).The patients with urine volume less than 200 ml in the infection group(50%)was more than that in the control group(15.6%)(χ2 =11.533,P <0.05).The CAPD age,triglycerides,fasting blood glucose,blood creatinine,blood phosphorus,calcium and phosphorus product of the infection group were higher than those of the control group(P <0.05).(5)Univariate analysis indicated that the CAPD age,triglycerides,fasting blood glucose,blood creatinine,blood phosphorus,calcium and phosphorus product,urine output less than 200 ml,primary disease distribution,urinary stones or structural changes were related factors for UTI in CAPD patients.These related single factors were used in multivariate binary logistic regression analysis.Urine output less than 200ml(OR=3.519,P <0.05)and urinary stones or structural changes(OR=4.727,P <0.05)were independent risk factors for UTI.Conclusion(1)The types of pathogenic bacteria cultured in urine were complex and diverse when UTI occurred in CAPD patients.(2)The drug resistance rate of the bacterial flora cultured in urine was high in CAPD patients with UTI.ESBL-producing bacteria and MRSA were increasing with the abuse of antibiotics which increased the difficulty of clinical treatment.It was best to choose antibiotics according to the sensitivity of the drug.In order to avoid ineffective anti-infection or double infection,it was necessary to know the pharmacokinetics of antibiotics.(3)The increase of CAPD age,the increase of triglycerides,fasting blood glucose,blood creatinine,blood phosphorus,calcium and phosphorus product,and the decrease of urine output primary disease distribution,urinary stones or structural changes were related factors for UTI in CAPD patients.Urine output less than 200 ml and urinary stones or structural changes were independent risk factors of UTI in CAPD patients.If there was residual urine in CAPD patients,it was necessary to perfect urine culture regardless of whether there were symptoms of UTI.(4)The incidence of urinary tract infections in CAPD patients can be reduced by controlling various risk factors. |
