糖尿病对泌尿系感染病原菌分布及 耐药性的影响分析

Effect of Diabetes Mellitus on Pathogen Distribution and Antimicrobial Resistance in Urinary Tract Infections

摘要: 【目的】分析2020~2024年本院糖尿病与非糖尿病患者泌尿系感染病原菌的分布特征及其对抗菌药物的耐药性差异，为临床个体化用药提供依据。【方法】回顾性分析青岛大学附属医院5217例中段尿培养阳性患者的菌株鉴定与药敏试验结果。采用SPSS 27.0进行统计分析，计数资料以例数(百分比)表示，组间比较采用χ²检验，检验水准α = 0.05。【结果】共检出病原菌5217株，两组均以革兰阴性菌为主(DM组74.19%，non-DM组74.05%)。DM组真菌占比高于non-DM组(10.24% vs 5.60%)。在大肠埃希菌中，DM组对左氧氟沙星的耐药率显著高于non-DM组(65.91% vs 62.27%, P = 0.049)，而对头孢噻肟(43.61% vs 51.27%, P < 0.001)、亚胺培南(0.45% vs 1.50%, P = 0.009)的耐药率显著低于non-DM组。在屎肠球菌中，DM组对四环素的耐药率显著低于non-DM组(32.33% vs 59.10%, P < 0.001)；在粪肠球菌中，DM组对莫西沙星的耐药率亦显著低于non-DM组(8.20% vs 19.66%, P = 0.038)。热带念珠菌中，DM组对伏立康唑的耐药率显著高于non-DM组(41.82% vs 22.22%, P = 0.038)。【结论】糖尿病与非糖尿病患者泌尿系感染病原菌谱存在差异，糖尿病患者真菌感染比例更高。糖尿病患者大肠埃希菌对氟喹诺酮类药物耐药形势更为严峻，临床应谨慎经验性使用；碳青霉烯类及部分头孢菌素类药物在糖尿病患者中仍保持较好敏感性，具有重要治疗价值。糖尿病患者肠球菌对四环素及莫西沙星的耐药风险较低，但热带念珠菌对伏立康唑的耐药风险显著升高，经验性抗真菌治疗时需注意菌种差异。

Abstract: Objective: To analyze the distribution characteristics of pathogens causing urinary tract infections (UTIs) and the differences in antimicrobial resistance between diabetic and non-diabetic patients at our hospital from 2020 to 2024, providing evidence for clinical individualized medication. Methods: A retrospective analysis was conducted on bacterial identification and antimicrobial susceptibility test results from 5217 patients with positive midstream urine cultures at the Affiliated Hospital of Qingdao University. Statistical analysis was performed using SPSS 27.0. Enumeration data were expressed as numbers (percentages), and intergroup comparisons were made using the χ² test, with a significance level of α = 0.05. Results: A total of 5217 pathogenic strains were detected, with Gram-negative bacteria predominating in both groups (DM group 74.19%, non-DM group 74.05%). The proportion of fungi in the DM group was higher than that in the non-DM group (10.24% vs 5.60%). Among Escherichia coli, the DM group showed a significantly higher resistance rate to levofloxacin (65.91% vs 62.27%, P = 0.049), but significantly lower resistance rates to cefotaxime (43.61% vs 51.27%, P < 0.001) and imipenem (0.45% vs 1.50%, P = 0.009) compared to the non-DM group. Among Enterococcus faecium, the DM group had a significantly lower resistance rate to tetracycline (32.33% vs 59.10%, P < 0.001); among Enterococcus faecalis, the DM group also showed a significantly lower resistance rate to moxifloxacin (8.20% vs 19.66%, P = 0.038). For Candida tropicalis, the DM group had a significantly higher resistance rate to voriconazole (41.82% vs 22.22%, P = 0.038). Conclusion: The pathogen profiles of urinary tract infections differ between diabetic and non-diabetic patients, with a higher proportion of fungal infections in diabetic patients. Diabetic patients face a more severe resistance profile of E. coli to fluoroquinolones, warranting caution in empirical use. Carbapenems and certain cephalosporins retain good susceptibility in diabetic patients, representing valuable therapeutic options. Diabetic patients show lower resistance risk of Enterococcus to tetracycline and moxifloxacin, but a significantly higher resistance risk of Candida tropicalis to voriconazole, which should be considered in empirical antifungal therapy.