田思,陈青,陈大为,等.康复医学科脊髓损伤患者尿路感染的病原菌分布及其危险因素分析[J].中华物理医学与康复杂志,2025,47(2):138-142
扫码阅读全文
|
| 康复医学科脊髓损伤患者尿路感染的病原菌分布及其危险因素分析 |
|
| |
| DOI：10.3760/cma.j.cn421666-20230420-00324 |
| 中文关键词: 脊髓损伤 尿路感染 神经源性膀胱 尿动力学 |
| 英文关键词: Spinal cord injury Urinary tract infection Neurogenic bladder Urodynamics |
| 基金项目:重庆市教委科学技术研究计划项目(KJQN202100409)；重庆市卫生适宜技术推广项目(2020jstg042) |
|
| 摘要点击次数: 557 |
| 全文下载次数: 622 |
| 中文摘要: |
| 目的 探讨重庆医科大学附属第一医院康复医学科病房内脊髓损伤患者尿路感染的病原学分布特点及其相关危险因素。 方法 收集符合入选和排除标准的脊髓损伤住院患者152例，按照尿路感染的诊断标准将其分为感染组77例和非感染组75例。采用单因素分析2组患者的性别、年龄、病因、病程、损伤平面、损伤程度、是否留置尿管、合并糖尿病、低蛋白血症、压疮、膀胱顺应性、最大膀胱测压容积、储尿期最大逼尿肌压、储尿期有无逼尿肌过度活动等因素与尿路感染的相关性，筛选出脊髓损伤患尿路感染可疑的危险因素。对单因素分析结果中脊髓损伤患者尿路感染可能的危险因素再进行多因素Logistic回归分析，以确定其独立危险因素。 结果 尿路感染患者中共检出病原菌124株，其中革兰阴性菌83株（66.94%），革兰阳性菌31株（25.00%），真菌9株（7.26%）,支原体1株（0.81%）。G-中最常见的为大肠埃希菌（42株，50.60%），G+中最常见的为屎肠球菌 （6株，19.35%）。尿路感染最常见的5种病原菌为大肠埃希菌（42株，33.87%），肺炎克雷伯菌（10株，8.06%），奇异变形杆菌（8株，6.45%），鲍曼不动杆菌（7株，5.65%），屎肠球菌（6株，4.84%）。单因素分析显示，临床资料中的病因、损伤平面、损伤程度、留置尿管、压疮，以及尿动力学检查中的最大膀胱测压容积、储尿期最大逼尿肌压和储尿期有无逼尿肌过度活动是脊髓损伤患者尿路感染可能的危险因素。Logistic回归分析显示，完全性损伤、留置尿管、储尿期最大逼尿肌压增高是脊髓损伤患者住院期间发生尿路感染的危险因素。 结论 康复医学科脊髓损伤患者住院期间尿路感染最常见的病原菌为大肠埃希菌；完全性损伤、留置尿管、储尿期最大逼尿肌压增高是脊髓损伤患者住院期间发生尿路感染的危险因素。 |
| 英文摘要: |
| Objective To investigate the distribution of pathogens and the risk of urinary tract infection for hospitalized spinal cord injury (SCI) patients. Methods A total of 152 hospitalized SCI patients with a urinary tract infection were randomly divided into a complicated infection group (77 cases) and an uncomplicated infection group (75 cases) according to the diagnostic criteria for urinary tract infection. Univariate analysis quantified any correlation of urinary tract infection with gender, age, etiology, course of disease, injury level, injury degree, indwelling catheter use, diabetes history, hypoproteinemia, pressure ulcers, bladder compliance, maximum bladder manometric volume, maximum detrusor pressure during urine storage and detrusor overactivity during urine storage. Multivariate logistic regressions were evaluated to determine the independent risk factors. Results A total of 124 pathogens were found in the subjects′ urine cultures. They included 83 gram-negative (G-) bacteria (66.94%), 31 gram-positive (G+) bacteria (25.00%), 9 fungi (7.26%) and 1 mycoplasm. The most common G- pathogen was Escherichia coli (42, 50.60%) with Enterococcus faecium (6, 19.35%) the most common G+. Overall, the five most common pathogens were Escherichia coli (42 strains, 33.87%), Klebsiella pneumoniae (10 strains, 8.06%), Proteus mirabilis (8 strains, 6.45%), Acinetobacter baumannii (7 strains, 5.65%), and Enterococcus faecium (6 strains, 4.84%). The univariate analysis showed that the etiology, injury level, injury degree, an indwelling catheter, pressure ulcers, maximum cystometric capacity, maximum detrusor pressure and detrusor overactivity in the storage phase were predictors of infection. The multivariate logistic regression analysis revealed that complete injury, an indwelling catheter, and increased maximum detrusor pressure in the storage phase were the independent risk factors. Conclusions Escherichia coli is the most common pathogen causing urinary tract infection among SCI patients undergoing rehabilitation during hospitalization. Complete injury, an indwelling catheter, and increased maximum detrusor pressure in storage phase may be independent risk factors for urinary tract infection among such patients. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
