妊娠期妇女双J管定植细菌的临床研究
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摘要
目的探讨妊娠期妇女留置双J管后定植细菌的种类分布。方法收集某院泌尿外科2013年3月—2017年12月收治的妊娠期留置双J管的患者。根据留置双J管的时间,将其分成A组(置管时间≤1个月)和B组(置管时间>1个月)。所有患者在拔管前后分别进行膀胱尿及双J管细菌培养,比较分析两组患者膀胱尿及双J管定植细菌的种类及阳性检出率。结果共纳入妊娠输尿管梗阻患者237例,其中A组129例,B组108例。双J管细菌培养共检出细菌78株,A组检出35株,B组检出43株,两组患者均以革兰阴性杆菌为主,所占比率分别为54.29%、67.44%,其次为革兰阳性球菌,所占比率分别为37.14%、25.58%;检出细菌分别为大肠埃希菌(30株)、肠球菌属(12株)、葡萄球菌属(12株)、肺炎克雷伯菌(11株)及铜绿假单胞菌(7株)等。A、B两组患者的双J管细菌培养阳性率均高于膀胱尿培养,差异均有统计学意义(均P<0.05)。B组患者双J管细菌培养阳性率(39.81%)高于A组患者(27.13%),差异有统计学意义(P<0.05);而A、B两组患者的膀胱尿培养阳性率比较,差异无统计学意义(P>0.05)。结论妊娠妇女留置双J管定植的细菌主要是革兰阴性杆菌,且留置的时间越长,细菌定植的概率越高,培养阳性率更高。
Objective To explore species distribution of bacteria colonizing the indwelling double J tube in pregnant women.Methods From March2013 to December 2017,patients with double J tube during pregnancy in urology department of a hospital were collected.According to the time of indwelling double J tubes,they were divided into group A(indwelling time≤1 month)and group B(indwelling time>1 month).All patients underwent bladder urine and double J tube bacterial culture before and after extubation.Species and positive detection rates of bacteria in bladder urine and double J tube between two groups were compared and analyzed.Results A total of 237 pregnant women with ureteral obstruction were included in the study,129 cases in group A and 108 in group B.A total of 78 strains of bacteria were isolated in double J tube culture,35 strains in group A and 43 in group B.Gram-negative bacilli were predominant in both groups,accounting for 54.29% and 67.44% respectively,followed by grampositive cocci,accounting for 37.14% and 25.58% respectively;isolated bacteria were Escherichia coli(n=30),Enterococcus spp.(n=12),Staphylococcus spp.(n=12),Klebsiella pneumoniae(n=11),Pseudomonas aeruginosa(n=7)and so on.Positive rate of double J tube bacterial culture was higher than that of bladder urine culture in both group A and group B,difference were both statistically significant(both P<0.05).Positive rate of double J tube bacterial culture in group B was higher than that in group A(39.81% VS 27.13%,P<0.05),but there was no significant difference in the positive rate of bladder urine culture between group A and group B(P>0.05).Conclusion The main colonized bacteria for pregnant women who are inserted double J tubes are gram-negative bacilli,the longer time the double J tube is placed,the higher rate the bacteria colonize and the higher positive of bacterial culture.
Objective To explore species distribution of bacteria colonizing the indwelling double J tube in pregnant women.Methods From March2013 to December 2017,patients with double J tube during pregnancy in urology department of a hospital were collected.According to the time of indwelling double J tubes,they were divided into group A(indwelling time≤1 month)and group B(indwelling time>1 month).All patients underwent bladder urine and double J tube bacterial culture before and after extubation.Species and positive detection rates of bacteria in bladder urine and double J tube between two groups were compared and analyzed.Results A total of 237 pregnant women with ureteral obstruction were included in the study,129 cases in group A and 108 in group B.A total of 78 strains of bacteria were isolated in double J tube culture,35 strains in group A and 43 in group B.Gram-negative bacilli were predominant in both groups,accounting for 54.29% and 67.44% respectively,followed by grampositive cocci,accounting for 37.14% and 25.58% respectively;isolated bacteria were Escherichia coli(n=30),Enterococcus spp.(n=12),Staphylococcus spp.(n=12),Klebsiella pneumoniae(n=11),Pseudomonas aeruginosa(n=7)and so on.Positive rate of double J tube bacterial culture was higher than that of bladder urine culture in both group A and group B,difference were both statistically significant(both P<0.05).Positive rate of double J tube bacterial culture in group B was higher than that in group A(39.81% VS 27.13%,P<0.05),but there was no significant difference in the positive rate of bladder urine culture between group A and group B(P>0.05).Conclusion The main colonized bacteria for pregnant women who are inserted double J tubes are gram-negative bacilli,the longer time the double J tube is placed,the higher rate the bacteria colonize and the higher positive of bacterial culture.
引文
[1]戴晓农,周益军,孙柳静.输尿管镜术后发生泌尿道感染的危险因素分析[J].微创泌尿外科杂志,2018,7(2):109-111.
[2]Gilbert NM,O’Brien VP,Hultgren S,et al.Urinary tract infection as a preventable cause of pregnancy complications:opportunities,challenges,and a global call to action[J].Glob Adv Health Med,2013,2(5):59-69.
[3]张淑红,刘红敏,赵洪方.中段尿培养的病原菌分布及耐药分析[J].山东大学学报(医学版),2014,52(S1):114-115.
[4]Sabir N,Ikram A,Zaman G,et al.Bacterial biofilm-based catheter-associated urinary tract infections:Causative pathogens and antibiotic resistance[J].Am J Infect Control,2017,45(10):1101-1105.
[5]罗甫花,姜维,蒋晓军,等.黏液型肺炎克雷伯菌耐药性[J].中国感染控制杂志,2015,14(5):314-316.
[6]顾金华,杨荣华,姚中民,等.留置导尿管表面生物膜细菌学检测的临床价值[J].2003,13(9):814-816.
[7]薛金雄.双J管表面垢层中纳米细菌的培养和鉴定[D].南昌:南昌大学,2012.
[8]欧阳津,段金云,王勇,等.妊娠不同时期泌尿系统感染筛查的意义---附123例报告[J].新医学,2004,35(8):477-479.
[9]王世平,翟艳慧,谢克亮.输尿管支架管细菌生物被膜的病原菌分布及耐药性研究[J].中华医院感染学杂志,2013,23(23):5656-5658.
[10]Qu Y,Daley AJ,Istivan TS,et al.Antibiotic susceptibility of coagulase-negative staphylococci isolated from very low birth weight babies:comprehensive comparisons of bacteria at different stages of biofilm formation[J].Ann Clin Microbiol Antimicrob,2010,9:16.
[11]肖国虎,陈勇,翁敏杰.妊娠妇女复发性泌尿道感染中无症状菌尿的特点及治疗[J].中华临床感染病杂志,2015,8(5):454-455.
[12]郑伟,茅一萍,韩方正,等.大肠埃希菌及肺炎克雷伯菌耐药性与抗菌药物使用强度相关性[J].中国感染控制杂志,2017,16(7):606-609.
[13]叶惠芬,刘平,陈惠玲.广州地区肺炎克雷伯菌分布和耐药性调查[J].实用医学杂志,2006,22(7):833-835.
[14]张肖肖,马传玲,刘海洋.临床分离肠球菌生物膜的形成能力及毒力基因的相关性研究[J].中国抗生素杂志,2016,41(11):869-873.
[15]Mohammad RN,Omer SA.Direct disk testing versus isolation and antimicrobial susceptibility testing of urine from urinary tract infection[J].Iran J Microbiol,2018,10(1):37-44.
[16]Kaplan JB.Biofilm dispersal:mechanisms,clinical implications,and potential therapeutic uses[J].J Dent Res,2010,89(3):205-218.
[17]叶海云,候树坤,曲星珂,等.细菌生物膜对尿管相关性尿路感染的影响[J].中华泌尿外科杂志,2006,27(2):135-138.
[18]赵旭,赵璐,严向明.细菌生物膜的形成与导管相关性尿路感染的关系[J].中华医院感染学杂志,2017,27(18):4154-4158.
[19]易辉,祖瑞铃,易玉玲,等.隐丹参酮对表皮葡萄球菌生物膜的抑制作用[J].中国感染控制杂志,2017,16(9):798-803.
[2]Gilbert NM,O’Brien VP,Hultgren S,et al.Urinary tract infection as a preventable cause of pregnancy complications:opportunities,challenges,and a global call to action[J].Glob Adv Health Med,2013,2(5):59-69.
[3]张淑红,刘红敏,赵洪方.中段尿培养的病原菌分布及耐药分析[J].山东大学学报(医学版),2014,52(S1):114-115.
[4]Sabir N,Ikram A,Zaman G,et al.Bacterial biofilm-based catheter-associated urinary tract infections:Causative pathogens and antibiotic resistance[J].Am J Infect Control,2017,45(10):1101-1105.
[5]罗甫花,姜维,蒋晓军,等.黏液型肺炎克雷伯菌耐药性[J].中国感染控制杂志,2015,14(5):314-316.
[6]顾金华,杨荣华,姚中民,等.留置导尿管表面生物膜细菌学检测的临床价值[J].2003,13(9):814-816.
[7]薛金雄.双J管表面垢层中纳米细菌的培养和鉴定[D].南昌:南昌大学,2012.
[8]欧阳津,段金云,王勇,等.妊娠不同时期泌尿系统感染筛查的意义---附123例报告[J].新医学,2004,35(8):477-479.
[9]王世平,翟艳慧,谢克亮.输尿管支架管细菌生物被膜的病原菌分布及耐药性研究[J].中华医院感染学杂志,2013,23(23):5656-5658.
[10]Qu Y,Daley AJ,Istivan TS,et al.Antibiotic susceptibility of coagulase-negative staphylococci isolated from very low birth weight babies:comprehensive comparisons of bacteria at different stages of biofilm formation[J].Ann Clin Microbiol Antimicrob,2010,9:16.
[11]肖国虎,陈勇,翁敏杰.妊娠妇女复发性泌尿道感染中无症状菌尿的特点及治疗[J].中华临床感染病杂志,2015,8(5):454-455.
[12]郑伟,茅一萍,韩方正,等.大肠埃希菌及肺炎克雷伯菌耐药性与抗菌药物使用强度相关性[J].中国感染控制杂志,2017,16(7):606-609.
[13]叶惠芬,刘平,陈惠玲.广州地区肺炎克雷伯菌分布和耐药性调查[J].实用医学杂志,2006,22(7):833-835.
[14]张肖肖,马传玲,刘海洋.临床分离肠球菌生物膜的形成能力及毒力基因的相关性研究[J].中国抗生素杂志,2016,41(11):869-873.
[15]Mohammad RN,Omer SA.Direct disk testing versus isolation and antimicrobial susceptibility testing of urine from urinary tract infection[J].Iran J Microbiol,2018,10(1):37-44.
[16]Kaplan JB.Biofilm dispersal:mechanisms,clinical implications,and potential therapeutic uses[J].J Dent Res,2010,89(3):205-218.
[17]叶海云,候树坤,曲星珂,等.细菌生物膜对尿管相关性尿路感染的影响[J].中华泌尿外科杂志,2006,27(2):135-138.
[18]赵旭,赵璐,严向明.细菌生物膜的形成与导管相关性尿路感染的关系[J].中华医院感染学杂志,2017,27(18):4154-4158.
[19]易辉,祖瑞铃,易玉玲,等.隐丹参酮对表皮葡萄球菌生物膜的抑制作用[J].中国感染控制杂志,2017,16(9):798-803.