| Background：Diabetes mellitus is a common chronic, metabolic diseases, in recentyears, the incidence of diabetes was still showing sustained growth trend,the number of people with diabetes increased to347million by2008, thisfigure is equivalent to9.5%of the total adult population[2].Another reportfor the United States with the prevalence of diabetes for all age-groupsworldwide was estimated to be2.8%in2000and4.4%in2030. The total numberof people with diabetes is projected to rise from171million in2000to366million in2030[1].Diabetes mellitus can combine with a variety ofchronic complications,the complications can involve multiplesystems,leading to organ dysfunction and failure,and even failure,and evendisabling or fatal.Except the complications, compared with non-diabeticpatients, diabetic patients are more susceptible to various infections,Urinary tract infections are the most common type of infection in diabeticpatients.Objective：To study the pathogen distribution and drug sensitivity of diabetespatients with urinary tract infection, meanwhile compare the urinarytract infections in diabetes with the diabetic non-urinary tractinfections, and analyze its risk factors,explore effective pre-treatmentmeasures,to provide reference for clinical empiric use of antimicrobialdrugs.Method：The hospitalized patients.were collected from January2011toDecember.2012in our hospital that at the First Hospital of Jilin University. To avoid the impact of the findings, select the217cases ofdiabetes patients with urinary tract infection,and analysis of theresults of urine specimens pathogen detection, to learn the distributionof pathogens and drug resistance, and select119cases of diabetes inpatients with non-urinary tract infections as the control groupsimultaneously, record patients’ gender, age, menopausal women case,body mass index, course of disease and other general information,Measuring FBG, HbA1c urine and comparison of various parameters.Theobtained data were statistically analyzed by SPSS16.0. Set P<0.05indicated the difference of statistically significance.Results：1.Analysis of the pathogens and drug resistance which is the urineculture-positive group of diabetic patients with urinary tractinfection:There were detected237of pathogens in the217cases of urinary tractinfection with diabetes in hospitalized patients, which Gram-negativebacteria accounted for73%,Gram-positive bacteria accounted for21.1%,fungi accounted for5.91%.Susceptibility test results showed that the urine samples isolatedGram-negative bacteria to imipenem, with Merlot can be more sensitive toamikacin, polymyxin and piperacillin/tazobactam and other antimicrobialagents; for most cephalosporins and fluoroquinolones antimicrobialresistance rate is higher, but the fluoroquinolone antibioticmoxifloxacin resistance was low (table2). In particular, the phenomenonof drug-resistant E. coli is more common, it tetracycline, piperacillin,ampicillin, sulfamethoxazole, ciprofloxacin, levofloxacin resistance upto65%.2.Analysis of basic data between diabetic infection andnon-infection groups (1)The average age of infection group and non-infection group was61.02±11.05and53.19±15.14years, respectively. There was significantdifference(P<0.01) between two groups.(2)Infection in women (86.18%), especially in postmenopausal women(55.08%), mostly (Table3). Non-infected group of women (accounting for50.42%), the gender composition of the two groups were significantlydifferent (P<0.05),(Figure1).(3)The BMI of infection group and non-infection group was24.92±3.58kg/m2and25.25±4.43kg/m2,respectively. There was nosignificant difference (P>0.05) between two groups.(4)The mean duration of infection≥10for91people (41.94%),<10years,126people (58.06%); non-infected group, the average duration of≥10for53people (44.54%),<10years66people (55.46%); no significantdifference (P>0.05)(table3), indicating that the course does notconstitute diabetes risk factors for urinary tract infections.3.Comparison of laboratory test data between diabetic infection andnon-infection groups(1)The average glycosylated hemoglobin level of infection group andnon-infection group was8.87±2.3%and9.33士3.2%,respectively. Therewas no significant difference (P>0.05) between two groups.(2)Infection group fasting plasma glucose was12.57±6.42mmol/l,fasting plasma glucose non-infected group was10.73±6.21, two fastingplasma glucose levels were significantly different (P<0.05)(Table3).(3)Urine glucose of infection group in positive was138people(63.59%)and in negative79people (36.41%), respectively. Urine glucoseof non-infection group in positive was50people (42.02%)and in negative69people (57.98%), respectively. There was significant difference(P<0.05) between two groups. Escription positive urine diabetes mayconstitute risk factors for urinary tract infections. Conclusion：(1)Diabetic patients with urinary tract infection urine cultureresults showed that: the main pathogenic is Gram-negative bacteria,Gram-positive cocci is the second one, Escherichia coli is most commonin Gram-negative bacteria.(2)Analysis the susceptibility results showed that:Gram-negativebacilli to aminoglycosides, carbapenem antibiotic, polymyxin, andcephamycins quinolone antibiotic moxifloxacin resistance rates low,penicillins, cephalosporins resistance rates may up to65%; Gram-positivecocci major pathogen Enterococcus faecalis sensitive to vancomycin,teicoplanin, linezolid, nitrofurantoin, fusidic acid, tetracycline andother antibacterial drugs, but to penicillin, cephalosporinsantibacterial drugs generally have a higher resistance rates; fungi on5-flucytosine, voriconazole, amphotericin B, fluconazole, itraconazoleresistance rates were0, higher sensitivity.(3)Analysis on the risk factors between the diabetes patients withurinary tract infections and the diabetes patients with non-urinary tractinfections, univariate analysis indicated that age, sex, postmenopausalstatus, and positive urinary glucose and higher fasting plasma glucosewere risk factors of diabetic patients complicated with urinary tractinfections.Multivariate Logistic regression revealed that elder age,female, positive urine glucose were independent risk factors of diabeticpatients complicated with urinary tract infections. |
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