目的 探讨钠-葡萄糖协同转运蛋白2(SGLT-2)抑制剂治疗2型糖尿病过程中并发尿路感染患者的病原菌分布及其耐药性。方法 回顾性分析2020-01至2023-12武警重庆总队医院门诊及住院使用SGLT-2抑制剂治疗2型糖尿病并发尿路感染患者共231例的临床资料,对其尿液样本、微生物培养和药敏试验方法进行分析。结果 共分离病原菌231株,其中革兰氏阳性菌37株(16.02%),革兰氏阴性菌182株(78.79%),真菌12株(5.19%)。革兰氏阳性菌中粪肠球菌18株(48.65%,18/37),屎肠球菌9株(24.32%,9/37);多重耐药菌14株(37.84%,14/37),其中粪肠球菌7株和屎肠球菌7株。革兰氏阴性菌中大肠埃希菌156株(85.71%,156/182),肺炎克雷伯杆菌13株(7.14%,13/182);多重耐药菌84株(46.15%,84/182),其中大肠埃希菌81株和肺炎克雷伯杆菌3株为产ESBLs菌株。药敏试验分析:大肠杆菌对氨苄西林和环丙沙星的耐药率最高(分别为81.94%和79.35%),对碳青霉烯类、替加环素和呋喃妥因的敏感性较高。肺炎克雷伯菌对喹诺酮类药物的耐药率为76.92%,对碳青霉烯类、替加环素和头孢哌酮/舒巴坦则完全敏感。粪肠球菌和屎肠球菌均对多种抗生素表现出较高的耐药性,但对万古霉素、替考拉宁和利奈唑胺敏感性高。结论 SGLT-2抑制剂治疗2型糖尿病患者并发尿路感染的病原菌分布以大肠埃希菌等革兰氏阴性菌为主,部分革兰氏阳性菌、少量真菌。由于SGLT-2抑制剂的药理机制,多重耐药菌占比较高,临床需据药敏试验合理用药。
Abstract
Objective To investigate the distribution and drug resistance of pathogens associated with urinary tract infections (UTIs) in the treatment of type 2 diabetes with sodium-glucose cotransporter 2 (SGLT-2) inhibitors. Methods A retrospective analysis was conducted on 231 patients with type 2 diabetes who were treated with SGLT-2 inhibitors and developed UTIs from January 2020 to December 2023 in Chongqing Municipal Corps Hospital of Chinese People's Armed Police Force. The distribution of pathogens and the resistance of the main isolates were analyzed using routine urine analysis, urine microbial culture and antimicrobial susceptibility testing. Results A total of 231 strains of pathogens were isolated, of which 37 were Gram-positive bacteria (16.02%), 182 were Gram-negative bacteria (78.79%), and 12 were fungi (5.19%). Among the Gram-positive bacteria, 18 strains were Enterococcus faecium (48.65%, 18/37) and 9 strains were Enterococcus faecalis (24.32%, 9/37); 14 strains were multidrug-resistant bacteria (37.84%, 14/37), including 7 strains each of enterococcus faecium and enterococcus faecalis. Among the Gram-negative bacteria, there were 156 strains of Escherichia coli (85.71%, 156/182) and 13 strains of Klebsiella pneumoniae (7.14%, 13/182); 84 strains were multidrug-resistant (46.15%, 84/182), of which 81 strains of Escherichia coli and 3 strains of Klebsiella pneumoniae produced extended-spectrum beta-lactamases (ESBLs).Antimicrobial susceptibility test showed that Escherichia coli had the highest resistance rate to ampicillin and ciprofloxacin (81.94% and 79.35%, respectively), but was more sensitive to carbapenems, tigecycline, and nitrofurantoin. Klebsiella pneumoniae demonstrated a resistance rate of 76.92% to quinolone antibiotics, but was completely sensitive to carbapenems, tigecycline, and cefepime/sulbactam. Both Enterococcus faecium and Enterococcus faecalis exhibited high resistance to a variety of antibiotics, yet showed high sensitivity to vancomycin, teicoplanin, and linezolid. Conclusions The main pathogenic bacteria in the treatment of type 2 diabetes patients with urinary tract infection by SGLT-2 inhibitors are Gram-negative bacteria such as Escherichia coli, with some infections also involving Gram-positive bacteria and a small amount of fungi. Due to the pharmacological mechanism of SGLT-2 inhibitors, there is a higher proportion of multidrug-resistant bacteria, and it is clinically essential to use medication rationally based on antibiogram results.
关键词
2型糖尿病 /
钠-葡萄糖协同转运蛋白2抑制剂 /
尿路感染 /
病原菌 /
药敏试验
Key words
type 2 diabetes /
inhibitor of sodium-glucose cotransporter 2 /
urinary tract infection /
pathogen /
antimicrobial susceptibility test
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基金
重庆市南岸区科卫联合医学科研项目(2023-04)
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