Objective To explore the microbiological etiology and antibiotic susceptibility of periopertive urinary tract infection (UTI) in patients undergoing hip or knee arthroplasty, so as to provide recommendations for antibiotic treatment. Methods A retrospective review was conducted for patients with perioperative UTI who underwent hip or knee arthroplasty between January 1st, 2013 and October 1st, 2015. Microbiological data and antibiotic susceptibility of bacteria were analyzed. Results A total of 117 strains of bacteria were identified, including 11 types of species. Among the organisms cultured, 86.3% (101 strains) were gram-negative bacteria, in which Escherichia coli was the most common causative organism (70.9%, 83 strains), followed by Klebsiella species (7.7%, 9 strains) and Proteus mirabilis (3.4%, 4 strains). And among the gram-positive bacteria detected, the proportion of Enterococcus faecalis and Feces Enterococcus was 6.8% (8 strains) and 3.4% (4 strains), respectively. The bacteria showed highly resistance to cephalosporins, quinolones and sulfonamides, but showed high sensitive to nitrofurantoin, carbopenems, the enzyme inhibitor complex and aminoglycoside antibiotics. Conclusions There is a diversity of bacteria involved in UTI, and the top 3 pathogens are Escherichia coli, Enterococcus faecalis and Klebsiella species. The resistance rate is high, and nitrofurantoin, amilacin, piperacillin-tazobactam, cefoperazone-sulbactam are the recommended antibiotics to treat the UTI, but the antibiotic should be adjusted according to susceptibility results.
ObjectiveTo explore the influence of evidence-based nursing care of catheterization on the incidence of urinary tract injury and urinary tract infection in patients with spinal cord injury and long-term indwelling catheters.MethodsFrom July 1st, 2017 to November 30th, 2018, 100 patients with spinal cord injury indwelling catheters in Department of Spinal Surgery were prospectively selected as the research objects. According to the admission time, patients admitted between July 2017 and February 2018 were assigned into the control group (n=50), and patients admitted between March 2018 and November 2018 were assigned into the observation group (n=50). Traditional catheter placement was used in the control group, while evidence-based catheter placement was used in the observation group. The incidences of catheter-related urethral injury and urinary tract infection after the catheterization were compared between the two groups.ResultsThere was no statistically significant difference in gender, age, diagnosis, or length of hospital stay between the two groups (P>0.05). Catheter placement was performed 57 times in the control group and 59 times in the observation group during hospitalization. After catheterization, the incidences of urethral hemorrhage and gross hematuria in the control group [22.80% (13/57) and 15.78% (9/57), respectively] were higher than those in the observation group [both were 1.69% (1/59)], with statistical differences between the two groups (P<0.05). The incidence of urinary tract infection in the control group differed from that in the observation group [42.0% (21/50) vs. 18.0% (9/50), P=0.009].ConclusionThe evidence-based urinary catheterization method for patients with spinal cord injury and long-term indwelling catheter can effectively prevent catheter-related urinary tract injury, reduce the incidence of catheter-related urinary tract infection during hospitalization, and improve the quality of clinical care.
摘要:目的:了解老年住院患者發生尿路感染的病因,為臨床治療提供依據。方法:回顧性分析我院2007年1月至2007年12月發生尿路感染的老年住院患者臨床資料,分別統計各種病因。結果:共收集52例臨床資料,發生上尿路感染17例,下尿路感染35例。前列腺增生或前列腺炎6例,尿路結石7例,單純尿路感染10例。結論:老年人由于器官衰老萎縮和免疫功能減退,抗病毒能力下降,尿路感染是老年人常見的疾病之一,應引起重視,注意根據尿細菌培養結果與尿藥物敏感結果使用敏感抗生素,并注意保護腎功能。
ObjectiveTo explore the risk factors of community-acquired urinary tract infections caused by extended-spectrum β-lactamase-producing Escherichia coli (ESBLs-producing Escherichia coli). MethodsProspective and retrospective investigation methods were combined, to investigate the hospitalized patients diagnosed with community-acquired urinary tract infections caused by ESBLs-producing Escherichia coli in the Second Affiliated Hospital of Fujian Medical University during July 2012 to December 2014. Statistical analysis was performed using SPSS 19.0 software. The potential risk factors were analyzed by chi-square test or Fisher exact probability method, then, factors with statistical significance identified by single factor analysis were further analyzed by non-conditional logistic regression. ResultsA total of 106 patients were included and divided into a ESBLs group (68 cases) and a control group (38 cases) according to the drug sensitivity test results. The results of single factor analysis indicated: there were significant differences between the ESBLs group and the control group in the use of antibiotics within three months before admission (χ2=11.292, P=0.001), the use of third generation cephalosporin (χ2=11.033, P=0.001), more than three kinds of diseases that could cause urinary tract obstruction (χ2=16.464, P=0.000), anemia (χ2=5.956, P=0.015), indwelling catheter (χ2=6.695, P=0.010), urinary system operations (χ2=9.730, P=0.002). The results of further non-conditional logistic regression analysis showed that more than three kinds of diseases that could cause urinary tract obstruction (OR=14.675, 95%CI 2.699 to 79.796, P=0.002), anemia (OR=7.976, 95%CI 1.785 to 35.632, P=0.007), the use of antibiotics within three months before admission (OR=7.057, 95%CI 1.597 to 31.175, P=0.010), the use of third generation cephalosporin (OR=6.344, 95%CI 1.145 to 35.146, P=0.034) and indwelling catheter (OR=3.844, 95%CI 1.058 to 13.967, P=0.041) were independent risk factors of community-acquired urinary tract infections caused by ESBLs-producing Escherichia coli. ConclusionThe risk factors of community-acquired urinary tract infections caused by ESBLs-producing Escherichia coli include more than three kinds of diseases that could cause urinary tract obstruction, anemia, the use of antibiotics within three months before admission, the use of third generation cephalosporin, and indwelling catheter. The use of antibiotics, especially the third generation cephalosporin, should be strictly controlled, the time of indwelling catheter should be reduced, and the anemia should be corrected, in order to reduce the incidence of community-acquired urinary tract infections caused by ESBLsproducing Escherichia coli.
One-hundred and thirty cases of hymenosis of female urethral orifice with anomalies from May, 1985 through October, 1990 were studied. The patients all received plastic reconstruction of the urethral orifice, and have been followed up for 3 months to 6 years with a cure and improvement rate of 92.1 percent. This anomaly is one of the important causes causing infection of the lower urinary tract. The mechanism of the pathology and the principles of treatment were discussed.
ObjectiveTo investigate the distribution and antibiotic resistance of pathogens isolated from children with primary nephrotic syndrome (PNS) complicated with urinary tract infection (UTI), so as to provide references for reasonable use of anti-infective agents in clinical practice. MethodsA total of 218 eligible patients who hospitalized in our department between January 2009 and December 2012 were included, and the data of distribution and antibiotic resistance of pathogens were analyzed retrospectively. ResultsIn this cohort, asymptomatic UTI in children with PNS accounted for 75.7% (165/218). And a total of 249 pathogenic strains were isolated and cultivated. The main pathogens of those subjects were G- bacilli, accounting for 64.3% (160/249), and 63.8% (102/160) of G- bacilli was Escherichia coli (E.coli); G+ cocci accounted for 31.7% (79/249), and 59.5% (47/79) of them was Enterococci faecalis; and fungi accounted for only 4.0%. Drug-susceptibility testing suggested that E.coli had a high resistance rate to hydroxyl ampicillin, cefazolin and ceftriaxone (>50%), but had lower resistance rate to cefoperazone/sulbactam and imipenem (<10%). Enterococci faecalis had a high resistance rate to rifampicin (74.6%), but had low resistance to vancomycin and linezolid (<10%). ConclusionAsymptomatic UTI is common in children with PNS. E.coli is the major pathogen and the proportion of enterococcus infection is also not low, and these pathogens have a high antibiotic resistance and most of them are multi-resistant.
ObjectiveTo investigate the species and resistance phenotypes of the pathogens causing catheter-associated urinary tract infection (CAUTI) in critically ill patients in West China Hospital of Sichuan University, and to provide the basis for the prevention and treatment of this kind of infection. MethodsThe clinical data and findings of the laboratory examination of the patients, who were admitted to intensive care units and suffered from CAUTI in our hospital during January 2012 to December 2014, were retrospectively analyzed. The pathogens isolates from the urine specimens of the patients with CAUTI and their resistance phenotypes were analyzed. ResultsThree hundred and seventy patients suffering from CAUTI were included in this study. Five hundred and seventeen strains of pathogens were isolated from the urine specimens of these patients, including 222 isolates (42.9%) of fungus, 181 isolates (35.0%) of gram negative bacteria, and 114 isolates (22.0%) of gram positive bacteria. In terms of species distribution, Candida albicans (105 isolates, 20.3%), C.glabrata (78 isolates, 15.1%) and C.glabrata (30 isolates, 5.8%) were the predominant fungus. Among the gram negative bacteria, Escherichia coli (81 isolates, 15.7%), Klebsiella pneumoniae (37 isolates, 7.2%), and Acinetobacter calcoaceticus-baumannii complex (23 isolates, 4.4%) were the main species. Enterococcus faecium (79 isolates, 15.3%) and E.faecalis (13 isolates, 2.5%) were the frequently isolated gram positive bacteria. Analysis of the resistance phenotype showed that the resistance rates to itraconazole, voriconazole and fluconazole of Candida spp. were above 10%. Thirty percent of the isolates of E.coli and K.pneumoniae, and 60% of the isolates of A.calcoaceticus-Baumannii complex were resistant to many of the regular antibiotics. Imipenem resistance rate of A.calcoaceticus-Baumannii complex was 60.8%. Sixty percent of the isolates of E.faecium and E.faecalis were resistant to many of the regular antibiotics. The vancomycin-resistant isolates accounted for 16.5% of E.faecium and 31.0% of E.faecalis. ConclusionCandida species are the major pathogens for CAUTI in critically ill patients in our hospital and show the resistance to azoles. We should focus on the drug resistance of gram negative bacteria and gram positive bacteria. The rational use of antibiotics and application of effective infection control measures are important to decrease the CAUTI.
ObjectiveTo analyze the related risk factors for catheter-associated urinary tract infection in the Intensive Care Unit (ICU), and make corresponding nursing countermeasures. MethodsBy target monitoring of catheter-associated urinary tract infection in 184 patients in the ICU from 2011 to 2012, infection risk factors were analyzed. The measures of nursing interventions had been taken since January 2012, and the effects before and after the intervention were contrasted and evaluated. ResultsBefore the intervention, 951 out of 1 229 patients in 2011 had indwelling catheter, and catheter-associated urinary tract infection occurred in 127 patients with an infection rate of 13.35%. After the intervention, 841 out of 1 437 in 2012 had indwelling catheter, and catheter-associated urinary tract infection occurred in 57 patients with an infection rate of 6.78%. ConclusionTaking effective intervention measures can effectively reduce the ICU catheter-associated urinary tract infection and it also ensures the safety of medical care.