糖尿病患者与非糖尿病患者尿路感染的临床特征。
Clinical profile of urinary tract infections in diabetics and non-diabetics.
作者信息
Aswani Srinivas M, Chandrashekar Uk, Shivashankara Kn, Pruthvi Bc
机构信息
Department of Internal Medicine, Kasturba Medical College, Manipal University, Manipal, India.
Former Associate Professor, Department of Internal Medicine, Kasturba Medical College, Manipal University, Manipal, India.
出版信息
Australas Med J. 2014 Jan 31;7(1):29-34. doi: 10.4066/AMJ.2014.1906. eCollection 2014.
BACKGROUND
The risk of urinary tract infection (UTI) is higher in diabetics compared to non-diabetics. The aetiology and the antibiotic resistance of uropathogens have been changing over the past years. Hence the study was undertaken to determine if there are differences in clinical and microbiological features of UTI between diabetic and non-diabetic subjects, to study the influence of diabetes mellitus on the uropathogens and antibiotic sensitivity pattern in patients with UTI.
METHOD
A total of 181 diabetics (83 males and 98 females) and 124 non-diabetic subjects (52 males and 72 females) with culture positive UTI were studied. Patients with negative urine culture (n= 64), those diagnosed and treated outside (n= 83) and not willing to participate in the study (n= 24) were excluded.
RESULTS
Almost 30 per cent of the patients (both diabetics and nondiabetics) presented with asymptomatic bacteriuria and the prevalence of pyelonephritis was significantly higher (p= 0.04) in diabetics compared to non-diabetic patients. The majority of the diabetics with UTI (87.14 per cent) had glycosylated haemoglobin (HbA1c) > 6.5 per cent with p < 0.001. The isolation rate of Escherichia coli (E. coli) from urine culture was higher (64.6 per cent) among diabetic patients followed by Klebsiella (12.1 per cent) and Enterococcus (9.9 per cent). The prevalence of extendedspectrum beta-lactamase (ESBL) producing E.coli was significantly higher in diabetics (p= 0.001) compared to nondiabetics. E.coli showed maximum sensitivity to carbapenems in both diabetic and non-diabetic subjects and least susceptibility to ampicillin.
CONCLUSION
The prevalence of pyelonephritis is significantly higher in diabetics than in non-diabetic subjects, with E. coli being the most common isolate. Elevated glycosylated hemoglobin (HbA1c) predisposes diabetics to UTI. Investigation of bacteriuria in diabetic patients for urinary tract infection is important for treatment and prevention of renal complications.
背景
与非糖尿病患者相比，糖尿病患者发生尿路感染（UTI）的风险更高。在过去几年中，尿路病原体的病因及抗生素耐药性一直在发生变化。因此开展此项研究，以确定糖尿病和非糖尿病患者UTI的临床和微生物学特征是否存在差异，研究糖尿病对UTI患者尿路病原体及抗生素敏感性模式的影响。
方法
对总共181例糖尿病患者（83例男性和98例女性）和124例UTI培养阳性的非糖尿病患者（52例男性和72例女性）进行了研究。尿培养阴性的患者（n = 64）、在院外诊断和治疗的患者（n = 83）以及不愿意参与研究的患者（n = 24）被排除。
结果
近30%的患者（糖尿病患者和非糖尿病患者）表现为无症状菌尿，与非糖尿病患者相比，糖尿病患者肾盂肾炎的患病率显著更高（p = 0.04）。大多数UTI糖尿病患者（87.14%）糖化血红蛋白（HbA1c）> 6.5%，p < 0.001。糖尿病患者尿培养中大肠埃希菌（E. coli）的分离率较高（64.6%），其次是克雷伯菌（12.1%）和肠球菌（9.9%）。与非糖尿病患者相比，糖尿病患者中产超广谱β-内酰胺酶（ESBL）大肠埃希菌的患病率显著更高（p = 0.001）。在糖尿病和非糖尿病患者中，大肠埃希菌对碳青霉烯类药物的敏感性最高，对氨苄西林的敏感性最低。
结论
糖尿病患者肾盂肾炎的患病率显著高于非糖尿病患者，大肠埃希菌是最常见的分离菌株。糖化血红蛋白（HbA1c）升高使糖尿病患者易患UTI。对糖尿病患者的菌尿进行尿路感染调查对于治疗和预防肾脏并发症很重要。
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