Analysis of pathogen distribution and risk factors of complicated urinary tract infection in patients with diabetic nephropathy
Objective This study aims to analyze the distribution of pathogens and identify the associated risk factors of complicated urinary tract infections(cUTI)in patients with diabetic kidney disease(DKD).Methods A retrospective analysis was conducted,including 72 hospitalized patients diagnosed with DKD complicated by cUTI from May 2022 to May 2024.Additionally,72 DKD patients without cUTI were selected as the control group.Clinical data were collected,including age,gender,duration of diabetes,renal function indicators(eGFR),glycemic control(HbA1c),complications,and medication usage.All patients underwent pathogen culture and antimicrobial susceptibility testing from urine or blood samples.Univariate analysis was used to screen for potential risk factors,and multivariate logistic regression was performed to determine the independent risk factors.Results A total of 84 strains of pathogens were isolated from the 72 patients with cUTI,among whom 13 patients(18.06％)had multiple infections.The predominant pathogens were Escherichia coli(34 strains,40.47％),Klebsiella spp.(16 strains,19.04％),Enterococcus spp.(11 strains,13.09％),and Pseudomonas aeruginosa(8 strains,9.52％).Additionally,Proteus mirabilis(4 strains,4.88％),Acinetobacter baumannii(3 strains,3.66％),Enterobacter spp.(3 strains,3.66％),Citrobacter freundii(2 strains,2.44％),Staphylococcus aureus(2 strains,2.44％),Serratia spp.(1 strain,1.22％),and Providencia spp.(1 strain,1.22％)were also identified.Antibiotic resistance analysis revealed that E.coli had a resistance rate of 36.10％to ceftriaxone,28.90％to levofloxacin,and a high sensitivity of 91.80％to imipenem.Klebsiella spp.showed a resistance rate of 31.40％to ceftriaxone,24.70％to levofloxacin,and an imipenem sensitivity of 87.50％.Enterococcus spp.exhibited resistance rates of 41.70％to ampicillin and 52.30％to gentamicin.P.aeruginosa demonstrated a resistance rate of 50.00％to levofloxacin and 84.60％sensitivity to imipenem.Additionally,Proteus mirabilis had a resistance rate of 33.30％to ceftriaxone,and A.baumannii showed resistance rates of 66.70％to ceftriaxone and 60.00％to levofloxacin.Multivariate logistic regression analysis identified poor glycemic control(HbA1c ≥8％)(OR=2.94,95％CI:1.35-6.45,P=0.005),decreased eGFR(OR=3.22,95％CI:1.49-6.93,P=0.003),urinary tract obstruction(OR=2.48,95％CI:1.18-5.21,P=0.016),and elevated systolic blood pressure(SBP≥140 mmHg)(OR=1.98,95％CI:1.10-3.58,P=0.027)as independent risk factors for cUTI in DKD patients.Conclusion The primary pathogens causing cUTI in DKD patients were Escherichia coli and Klebsiella spp.,with relatively high resistance rates to commonly used antibiotics such as ceftriaxone and levofloxacin.Maintaining optimal glycemic control,preserving renal function,and early detection and management of urinary tract obstruction are crucial for the prevention and treatment of cUTI.
NETL
NSTL
万方数据
