糖尿病患者尿路病原体的流行情况及其抗生素耐药模式。
Prevalence of uropathogen and their antibiotic resistance pattern among diabetic patients.
作者信息
Nigussie Demiss, Amsalu Anteneh
机构信息
Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
Department of Medical Microbiology, College of Medicine and Health Sciences, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia.
出版信息
Turk J Urol. 2017 Mar;43(1):85-92. doi: 10.5152/tud.2016.86155. Epub 2017 Jan 27.
OBJECTIVE
Diabetes mellitus (DM) and antibiotic resistance is an emerging public health problem in Ethiopia. Urinary tract infections (UTIs) are common and occasionally life-threatening condition among diabetic patients. Despite, all these problems, antibiotics are prescribed empirically which may adversely affect antibiotic resistance so far. Therefore the aim of this study was to identify the etiologic agents of UTI and their antibiotic resistance pattern among diabetic patients attending diabetic clinic of Hawassa University Referral Hospital.
MATERIAL AND METHODS
A cross-sectional study was conducted in a total of 240 diabetic patients from June to October, 2014. After obtaining an informed written consent, socio-demographic and clinical data were collected using pre-structured questionnaire. Clean catch mid-stream urine samples were collected and processed for identification of uropathogen through culture using standard microbiologic procedure. Antibiotic susceptibility test was carried out using Kirby-Bauer disc diffusion method.
RESULTS
The overall prevalence of diabetic UTI was 13.8%. Out of the total number of patients, 11.2% and 23.1% had asymptomatic and symptomatic bacteriuria respectively. DM patients with no previous history of UTI [AOR=3.55; 95% CI=1.186-10.611] and illiterate [AOR=2.5; 95% CI=1.052-5.989] had higher odds of UTI compared with their counterparts. was the commonest isolated uropathogen followed by coagulase-negative . All the isolated bacteria were resistant to ampicillin but sensitive to nitrofurantoin. Gram-negative isolates demonstrated high level of resistance to trimethoprim-sulphamethoxazole in 9 (81.8%), gentamicin in 8 (72.7%) and ceftriaxone in 7 (63.6%) patients. Gram-positive bacteria showed resistance to penicillin in 14 (87.5%), norfloxacin in 10 (62.5%) and ciprofloxacin in 8 (50.0%) patients. Multidrug resistance was observed in 93.9% of the isolated uropathogens.
CONCLUSION
Illiterate DM patients with no previous history of UTI were significantly associated with UTI. Nitrofurantoin can be used as a drug of choice for empiric treatment of UTI in the study area. Multidrug resistance to commonly used antibiotics is an alarming phenomenon. Therefore, performing of urine cultures and periodic surveillance of UTI among DM patients is necessary.
目的
糖尿病（DM）与抗生素耐药性是埃塞俄比亚一个新出现的公共卫生问题。尿路感染（UTIs）在糖尿病患者中很常见，偶尔会危及生命。尽管存在所有这些问题，但目前抗生素仍凭经验使用，这可能会对抗生素耐药性产生不利影响。因此，本研究的目的是确定在哈瓦萨大学转诊医院糖尿病门诊就诊的糖尿病患者中尿路感染的病原体及其抗生素耐药模式。
材料与方法
2014年6月至10月，对总共240名糖尿病患者进行了一项横断面研究。在获得知情书面同意后，使用预先设计的问卷收集社会人口统计学和临床数据。收集清洁中段尿样本，并采用标准微生物学程序通过培养进行尿路病原体鉴定。采用 Kirby-Bauer 纸片扩散法进行抗生素敏感性试验。
结果
糖尿病患者尿路感染的总体患病率为13.8%。在所有患者中，分别有11.2%和23.1%有无症状菌尿和有症状菌尿。与有UTI病史的糖尿病患者相比，无UTI病史的糖尿病患者[AOR = 3.55；95% CI = 1.186 - 10.611]和文盲糖尿病患者[AOR = 2.5；95% CI = 1.052 - 5.989]发生UTI的几率更高。大肠埃希菌是最常见的分离尿路病原体，其次是凝固酶阴性葡萄球菌。所有分离出的细菌对氨苄西林耐药，但对呋喃妥因敏感。革兰阴性菌分离株对甲氧苄啶 - 磺胺甲恶唑、庆大霉素和头孢曲松的耐药率分别为9例（81.8%）、8例（72.7%）和7例（63.6%）。革兰阳性菌对青霉素、诺氟沙星和环丙沙星的耐药率分别为14例（87.5%）、10例（62.5%）和8例（50.0%）。在93.9%的分离尿路病原体中观察到多重耐药。
结论
无UTI病史的文盲糖尿病患者与UTI显著相关。在研究区域，呋喃妥因可作为UTI经验性治疗的首选药物。对常用抗生素的多重耐药是一个令人担忧的现象。因此，对糖尿病患者进行尿培养和定期监测UTI是必要的。
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