Clinical And Pathogenic Analysis Of Urinary Tract Infections:Report Of292Cases

Objectives:We aim to understand the clinical features, pathogens and drug resistance in urinary tract infections by collecting patients’clinical data in our urology wards. These results may have good reference value for the diagosis and empirical treatment of urinary tract infections.Methods:We collected clinical data of292hospitalized patients who were diagnosed with urinary tract infections in recent6months in our urology wards. Age, gender, diagnosis of disease, clinical manifestation, blood and urine routine examination, renal function, surgery, usage of antimicrobial, uropathogens and drug resistance were analysed.Results:In292patients, the most common diseases were urolithiasis, prostatic disease and bladder cancer (the ratios were29.4%,23.3%,12.3%, respectively).341pathogens were isolated from these patients, in which Escherichia coli accounted for34.9%. Other common pathogens included Enterococcus faecalis (10.0%), Pseudomonas aeruginosa (6.2%), Streptococcus agalactiae (5.9%), and Enterococcus faecium (5.6%).56.3%of Escherichia coli isolates were extensive-spectrum β-lactamase producers, the rates of susceptibility were over80%for amikacin, cefotetan, imipenem, piperacillin/tazobactam. More than70%of Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii were susceptible to imipenem and cefepime. All of Enterococcus faecalis, Enterococcus faecium, and Staphylococcus epidermidis were sensitive to vancomycin and tigecycline. The ratio of Escherichia coli in female patients was significantly higher than that in male patients (51.6%vs24.9%, P<0.001). Escherichia coli accounted for48.4%,20.5%,39.0%of isolates from urolithiasis, prostatic disease, bladder cancer, respectively, and the rates of susceptibility were over70%for amikacin, imipenem, piperacillin/tazobactam. In86urolithiasis patients, Enterococcus faecalis, Streptococcus agalactiae had100%susceptibility rates of vancomycin, teicoplanin, linezolid and tigecycline, and over80%of which were susceptible to ampicillin, nitrofurantoin and penicillin G In68patients who suffered from prostatic disease,40(58.8%) patients had indwelling catheters when admitted to hospital, and16patients were pathologically diagnosed with prostatic cancer. In these patients, Pseudomonas aeruginosa were absolute sensitive to ciprofloxacin, amikacin, ceftazidime, piperacillin/tazobactam, and more than90%of which were susceptible to imipenem. Enterococcus faecalis had over85%susceptibility rates of ampicillin, nitrofurantoin, penicillin-G, vancomycin, teicoplanin and tigecycline. In36bladder cancer patients,7patients had undergone radical cystectomy. Isolates from bladder cancer patients included Escherichia coli, Enterococcus faecalis, Candida albicans and Enterococcus faecium. Conclusions:Urolithiasis, prostatic disease and bladder cancer are common original diseases in hospitalized patients who suffer from urinary tract infections in our urology wards. The most common pathogens are Escherichia coli, Enterococcus faecalis, Pseudomonas aeruginosa. The spectrum of pathogens has some differences between male and female patients. The majority of pathogens is Escherichia coli in female patients, while the common pathogens in male patients are Escherichia coli, Enterococcus spp and Pseudomonas aeruginosa. Enterococcus spp palys an important role in developing urinary tract infections in bladder cancer patients. Pseudomonas aeruginosa is an important pathogenic bacterium of prostatic disease and related catheter-associated urinary tract infections. The rate of extensive-spectrum β-lactamase producers is high in Escherichia coli. For empirical treatment, ciprofloxacin and levofloxacin may be the first choice. If they are not effective, they can be replaced by cephalosporins, piperacillin/tazobactam, amikacin and other drugs of the same class.