Clinical Analysis Of 217 Hospitalized Patients With Urinary Tract Infection

Objective(s):To analyze the clinical features and investigate the distribution and drug resistance of pathogenic bacteria in hospitalized patients with urinary tract infection(UTI).For the diagnosis and treatment of urinary tract infection and provide a scientific basis for rational drug use.Methods:Our center were rettrospectively analyzed between January 2013 and December 2015,217 cases of patients with urinary tract infection in hospital clinical data,laboratory examination,risk factors and pathogenic bacteria species and the antibiotic resistance.Results:1.Among the 217 UTI patients,165 were females(76.04%),and 52 were males(23.96%),females are significantly higher than males.The age was between 14-90 years old,mean age 49.99± 19.60 years old.Females and males have significantly differences in different ages(p<0·.05).2.The hospitalized patients with urinary tract infection in our center are major in complicated urinary tract infection(75.58%),apparent complexity of urinary tract infection rate among women than men,the difference was statistically significant(p<0.05).The major predisposing factors in urinary tract infections were urinary obstruction 80 cases(48.78%),urinary system structural abnormalities 27 cases(16.46%),diabetes 24 cases(14.63%),19 cases of pregnancy(11.56%),chronic kidney disease(CKD)16 cases(9.76%),8 cases of detaining urethral catheter(4.89%),long-term used immunosuppressants 4 cases(2.44%).3.The pathogens was detected in 86 cases out of 217 cases of UTI patients accounting for 39.6%positive rate.The pathogens were mainly gram-negative bacteria(75.58%),such as Escherichia coli(69.77%)to produce 60%extend spectrum beta lactamases(ESBLs).The others are gram-positive bacteria(18.60%),of which the most common for enterrococcus faecium(8.14%).For nearly three years of gram positive bacteria detection rate were 14.29%,14.29%,30.43%,is on the rise.Fungus accounted for 5.82%which mainly include candida albicans(3.49%).4.Gram-negative bacteria was resistant to cephalosporin and penicilin,especially in the first,second generation cephalosporin which the resistant rate>50%,while the resistance of commonly used cefotaxime has been as high as 62.5%in our center.The resistant to trimethoprim/sulfamethoxazole,levofloxacin and ciprofloxacin were more than 50%.Gram-negative bacteria was highly sensitive to amikacin and secondly sensitive to nitrofurantion,moxifloxacin,cefoperazone/sulbactam,meropenem,imipenem.The resistant rate of penicillin,erythrocin,clindamycin and amoxicillin were more than 80%,levofloxacin and ciprofloxacin more than 70%in Gram-positive bacteria.Gram-positive bacteria have no resistance to kuinu reptin/dafoe leptin,linezolid,vancomycin and tigecycline.There were five cases of fungus which were all sensitive to 5-fluorine cytosine and amphotericin B.5.The different detectable rate in different age level,the highest rate in less than 40 years old(75%).Escherichia coli have no resistance to amikacin,moxifloxacin and have lower resistance to imipenem,meropenem,nitrofurantoin,ertapenenm.Escherichia coli have highly resistance to ceftriaxone,ampicillin and piperacillin as high as 100%,and the resistant rate to levofloxacin and ciprofloxacin were more than 60%.The antibiotic resistance of ESBLs-producing was generally higher than non-ESBLs-producing,especially in trimethoprim/sulfamethoxazole,levofloxacin and ciprofloxacin with statistical significance(<0.05).Each age group had different resistance rate,the resistance rate of trimethoprim/sulfamethoxazole,ampicillin,levofloxacin and ciprofloxacin increased with the age.6.Among the 217 patients,131 cases have used antibiotic(60.37%),in 86 patients with positive urine culture,there were 48 cases of patients have used antibiotic(55.81%)in the pre-hospital.The above results suggest that,useing antibiotic prior to admission not influence the result of the urine culture(p>0.05).7.The high risk of the urinary tract infection are the more than 35 years old,the history of urinary tract infection,delivery history,history of abortion and anemia.Through the logistic regression analysis,the more than 35 years old is independent risk factor(p<0.05).Conclusion(s):1.From the data of this center hospitalized patients with urinary tract infection are major in female patients,and in different age exist gender distribution differences.The female was under the age of 40,the male was over 55.2.Gram-negative bacteria was still the main pathogens in urine culture,escherichia coli was the most major pathogen,the highest detectable tare in the age less than 40 years old,which produce ESBLs accounted for more than a half,which has a rising rend compared wiht in recent years.Gram-positive bacteria detection rate is low,but the detection rate is on the rise of nearly three years.3.The resistance rate of trimethoprim/sulfamethoxazole,ampicillin,levofloxacin and ciprofloxacin increased with the age.E.coli to most antimicrobial resistance mainly depends on ESBLs-producing,the resistance of non-ESBLs-producing is relatively low.4.The pathogenic bacteria has highly resistance in traditional recommend antimicrobial agents of urinary tract infection,such as cefotaxime,levofloxacin,ciprofloxacin and ampicillin,which are recommended to use the clinical experience administration,also have higher resistance in our center.Nitrofurantoin,ceftazidime,cefoperazone/sulbactam and moxifloxacin should be the new choice of antimicrobial agents for the treatment of urinary tract infection.5.The more than 35 years old is independent risk factor of urinary tract infections during pregnancy.