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投稿时间：2021-08-12 网络发布日期：2021-10-20
投稿时间：2021-08-12 网络发布日期：2021-10-20
中文摘要: 目的 探讨2型糖尿病（T2DM）老年患者急性肾盂肾炎（APN）病原微生物特点及对APN复发的影响。
方法 收集2018至2020年于牡丹江医学院附属红旗医院住院的T2DM合并APN的老年患者112例，分析致病菌的特点、分布及药敏试验结果。
结果革兰阴性（G-）细菌占比（77.05％）明显高于革兰阳性（G+）细菌（14.75％）及真菌（8.20％）。G-细菌对青霉素、头孢唑啉、左氧氟沙星等抗菌药物耐药性较高（>60%）；G+细菌对青霉素、红霉素、克林霉素等抗菌药物耐药性高（>70%）；真菌对5-氟尿嘧啶、伊曲康唑耐药性高（>70%）。随访6个月，APN复发率在真菌感染者（80.00％）较G-细菌感染者（14.89%）及G+细菌感染者增高（16.67％， P <0.01）。
结论 T2DM合并APN的老年患者以G-细菌感染为主，首次入院患者尿液中有真菌感染，其今后APN复发几率高。
Abstract:Objective
To investigate the characteristics of pathogenic microorganism of acute pyelonephritis (APN) and their impacts on APN recurrence in elderly patients with type 2 diabetes mellitus (T2DM).
Methods A total of 112 elderly inpatients with T2DM complicated with APN from 2018 to 2020 were enrolled to analyze the characteristics, distribution and drug sensitivity of pathogenic bacteria. Results
The proportion of Gram-negative bacteria（77.05%） in urine was significantly higher than that of Gram-positive bacteria（14.75%） and fungi(8.20%, P <0.05). Gram-negative bacteria were more resistant to penicillin, cefazolin, levofloxacin, etc.(>60%), and Gram-positive bacteria were highly resistant to penicillin, erythromycin, clindamycin, etc.(>70%). Fungi were highly resistant to 5-fluorouracil and itraconazole (>70%). After 6 months follow-up, the recurrence rate of APN in patients with fungal infection（80.00%） was higher than that in patients with G-bacterial infection（14.89%） and G+ bacterial infection (16.67%， P <0.05).
Conclusions
Gram-negative bacterial infection is more common in the elderly T2DM patients with APN. The recurrence rate of APN is higher in the patients admitted for the first time with urinary fungal infection.
keywords: Type 2 diabetes mellitus Acute pyelonephritis Elderly patients Pathogenic microorganism Fungi Drug resistance
文章编号： 中图分类号： 文献标志码：B
基金项目:黑龙江省卫生健康委科研课题(2018M391014)；牡丹江市科学技术计划项目(Z2018s068)
引用文本：
王德平,朱海夫,李承威,等.老年2型糖尿病患者急性肾盂肾炎病原微生物特点[J].中国临床研究,2021,34(10):1350-1353.
王德平,朱海夫,李承威,等.老年2型糖尿病患者急性肾盂肾炎病原微生物特点[J].中国临床研究,2021,34(10):1350-1353.