Clinical Characteristics And Pathogen Drug-resistance Analysis Of 886 Patients With Urinary Tract Infection In Zhumadian

BackgroundUrinary Tract Infection(UTI)is a common infectious disease caused by a variety of pathogenic bacteria that directly enter and invade the urinary tract and cause the inflammation.The commonly known pathogenic bacteria that can lead to UTI include Escherichia coli(E.coli),Staphylococcus aureus(S.aureus).The symptoms of UTI can be acute cystitis,acute nephritis etc.UTI has already been one of the commonest infectious diseases.The number of UTI cases has increased in Zhumadian recently.However,the clinical characteristics of UTI and the drug-resistance of pathogens that cause UTI are still unclear,which prevents the development of effective therapy for UTI.ObjectiveTo guide the clinical treatment and design effective therapy for UTI patients in Zhumadian area by systematically investigating the clinical characteristics of UTI and statistically analyzing the drug sensitivity of pathogens and relevant drug-resistant genes.MethodsFirst we collected data of 886 UTI patients hospitalized between January of 2007 and December of 2014 in four hospitals-City Center Hospital in Zhumadian,the First People's Hospital in Zhumadian,Zhumadian City Hospital and the Third People's Hospital in Zhumadian.The data includes the age,gender,clinical diagnosis and treatment information of each patient.The clinical characteristics,results of laboratory tests and treatment outcomes of these patients were systematically analyzed.Theevolution of pathogenic bacteria and their drug-resistant ability were analyzed by urine culture tests.Last but not least,we analyzed the drug-resistant genes in Escherichia coli(from 25 patients)and Klebsiella pneumoniae(from 15 patients),that can produce extended spectrum beta lactamases(ESBLs),by gel electrophoresis and polymerase chain reaction(PCR).Results1.Based on the data used in this research,186 cases(20.99%)were male patients and 700 cases(79.01%)were female patients.The ratio of male to female patients was1: 3.76.The percentage of female patients were higher than that of men among all ages.As for the infection paths of UTI,843 cases(95.15%)were ascending infection,20cases(2.25%)were blood infection,16 cases(1.81%)were lymph tract infection,7cases(0.79%)were direct infection,354 cases(39.95%)were upper urinary tract infection,with acute and chronic pyelonephritis,532 cases(60.05%)were lower urinary tract infection with acute cystitis,prostatitis and acute urethritis.The most common symptoms of UTI patients were urinary tract irritation(frequency,urgency,dysuria),followed by lower abdominal pain,low back pain and so on.In addition,30 patients didn't show obvious symptoms.460 cases of UTI patients showed complications.The most common complication is urinary calculi in 127 cases(27.61%),followed by hydronephrosis in 61 cases(13.26%).2.The pathogens were detected in 582 cases out of 886 cases of UTI patients,accounting for 65.69% positive rate.768 kinds of pathogens were detected.The pathogens were mainly G-bacteria(70.05%),such as Escherichia coli(51.43%);the others are G+ bacteria(28.65%),such as Enterococci feces(12.37%)and Enterococcus faecalis(5.73%).In the last four years,the number of UTI patients caused by G+bacteria infection tended to increase,mainly by Enterococcus feces and Enterococcus faecalis.3.Escherichia coli and Klebsiella pneumonia are highly resistant to multipleantimicrobial drugs,but highly sensitive to imipenem,nitrofurantoin,cefotetan,piperacillin/tazobactam,and cyproterone gatifloxacin.Enterococcus feces and Enterococcus faecalis are highly resistant to penicillin,erythromycin,ciprofloxacin,ampicillin,but highly sensitive to vancomycin,teicoplanin,nitrofurantoin.4.Among 25 stains of E.coli,the detection rate of SHV type,TEM type and CTXM type are 40.00%(10/25),8.00%(2/25)and 80.00%(20/25)respectively.Among 15 stains of Klebsiella pneumoniae,the detection rate of SHV type,TEM type and CTXM type are 40.00%(6/15),26.67%(4/15)and 73.33%(11/15)respectively.Conclusions1.The infection rates and clinical manifestations of UTI differ with age and gender.G-bacteria infection,especially Escherichia coli,is still the major cause of UTI.However,the number of UTI cases caused by G+ bacteria,such as Enterococcus feces and Enterococcus faecalis,has increased recently.2.Among all the pathogenic bacteria identified,Escherichia coli and Klebsiella pneumoniae are highly resistant to multiple kinds of antimicrobial drugs,including ampicillin,cotrimoxazole and piperacillin.Enterococcus Feces and Enterococcus faecalis are highly resistant to penicillin,erythromycin,ciprofloxacin and ampicillin.3.The genotype of the drug-resistant strain – Escherichia coli and Klebsiella pneumoniae that can produce ESBLs-is mainly CTX-M type,followed by SHV type and TEM type.Multiple drug-resistant genes can co-exist in the same bacteria,therefore the same bacteria can display multiple drug-resistant genotypes,which mediates complicated drug-resistant phenotypes.