Clinical Investigation And Pathogens Of Urinary Tract Infection With Chronic Renal Failure

[Objective] To investigate the pathogens, drag resistance and clinical characteristic in urinary tract infection patients with chronic renal failure and to provide suggestion for diagnosis and treatment.[Method] A restrospective analysis of 1057 in patients with chronic renal failure diagnosed from May 1998 to May 2006 in hospital were collected. Of the 1057 patients 195 had urinary tract infection.[Result] 1. The incidence of chronic glomerulonephritis was the hightest, which accounted for (58.94%) as the first place, followed by hypertensive nephropathy (18.35%) and diabetic nephropathy (11.35%). 2. The incidence of urinary tract infection patients with chronic renal failure was 18.45%. Of 195 patients with UTI: the infection rate of women was was significantly higher than that of men(P＜0.01). symptomatic UTI accounted for 12 cases(6.15%), asymptomatic UTI accounted for 183 cases(93.85%). In the patients, the occurrence rates of lumbago and percussion tenderness over kidney region, fever, leukocyturia, neutrophilia, leukocytosis and neutrophilia, leukocyte normal and neutrophilia, leucopenia and neutrophilia were 1.02%, 2.56%, 12.31%, 36.92%, 12.31%, 17.75%, 6.67%, respectively. the infection rate over 60 years of age(24.80%) was significantly higher than that of 19-40 years old(13.24%), 41-60 year old (15.60%)(P＜0.01). After the sensitive medicine treatment, the improvement rate of renal insufficiency compensatory and renal insufficiency decompensatory phase was significantly higher than that of renal failure and uremia stage(P＜0.01). Of 195 clinical isolated, E. coli accounted for 31.28% (61/195), coagulase negative staphylococci accounted for 27.69%(54/195), Entercoccus Spp accounted for 10.77% (21/195). 4. All the Gram-positive organism to vancomycins were susceptibility. The drug resistance of MRCNS was higher than that of MSCNS. Of the 54 coagulase negative staphylococci 23(42.59%) was MRCNS. The rate of resistance to penicillin, ampicillin, erythromycin, incomycin and ceftriaxone was 69.57%～96.65%. The rate of resistance to ciprofloxacin, levofloxacin, cefazolin. chloramphenicol, gentamycin was 17.39%～56.52%. In addition, the resistance rate of MSCNS and MSSA to penicillin and ampicillin was likeness. 5. The isolation rate of ESBLs in E. coli, Klebsiella spp and Enterbacter spp was 14.75%, 12.5% and 0% respectively. The resistance rate of E. coli to cefepime, ceftazidime, cefotaxime, cefoperazone, cefoperazone-sulbactam, ceftriaxone was 4.92%～19.67%. The resistance rate of E. coli to ciprofloxacin, levofloxacin, and ofloxacin was 45.90%～55.74%. The susceptibility rat of E. coli to amikacin, gentamycin and piperacillin was 88.52%, 55.74% and 62.30% respectively. 100% of Enterbacter spp isolates were susceptibility to imipenem.[Conclusion] 1. The incidence of urinary tract infection patients with chronic renal failure was 18.45%. The infection rate of women was was significantly higher than that of men. The more renal function impaired, the lower the improvement rate. 2. The clinical characteristic of urinary tract infection patients with chronic renal failure was not typical. Most of them was asymptomatic bacteriuria. The neutrophilia may be a clue. 3. The main pathogens of urinary tract infection patients with chronic renal failure were E. coli. Followed by coagulase negative staphylococci. The high isolation rate of ESBLs in Enterbacter spp and MRCNS should cause a clinical enough value. Clinical doctors should choose antibiotics rationally in urinary tract infection patients with chronic renal failure according to drug resistance test.