Efficacy of meropenem in the treatment of severe complicated urinary tract infections]

The clinical and bacteriological efficacies of meropenem in the treatment of 12 patients with urinary tract infection were studied. In 8 patients the drug was administered intravenously in a dose of 1 g every 8 hours and in 4 patients with the creatinine clearance below 50 ml/min it was administered in a dose of 1 g every 12 hours (the treatment course of 7 to 10 days). Meropenem was used in the monotherapy. Severe complicated urinary tract infections were mainly observed in the patients with long-term urolithiasis, subjected to repeated surgical interventions and isolating as a rule polyresistant strains of Pseudomonas aeruginosa and E.agglomerans as the pyelonephritis pathogens at a titre of 5 x 10(5)-5 x 10(8) microbial cells per 1 ml of the urine susceptible to meropenem in 80 to 96 per cent of the cases. The clinical efficacy of the drug was stated in all the patients while the bacteriological efficacy amounted to 88.9 per cent.     

Therapy of urinary tract infections in patients with diabetes mellitus]

Clinical and microbiological efficacy of Cifran OD (Ranbaxy, India), a formulation with prolonged action and extended release of ciprofloxacin was studied in 22 patients with bacteriuria and lingering diabetes mellitus. Ciprofloxacin was used in doses of 500 or 1000 mg orally once a day depending on the severity of the disease singns for 2-3 weeks as etiotropic therapy and only in 2 cases with severe pyelonephritis it was used intravenously drop-wise and orally simultaneously. Twenty eight microbial strains isolated from urea of the patients were tested. The main species of the isolates belonged to the family Enterobacteriaceae. Twenty five isolates (89.3%) were susceptible to ciprofloxacin and 3 isolates (10.7%) were resistant. The clinical efficacy of ciprofloxacin was 90.9%.     

泌尿系统结石合并感染患者尿路病原菌分布及危险因素分析

目的 分析泌尿系统结石合并感染患者尿路病原菌分布及其危险因素,为后续研究提供参考。 方法 收集2016年1月至2019年1月我院诊治的430例泌尿系统结石患者为研究对象,根据患者是否发生感染分为感染组(n=34)和非感染组(n=396)。分析两组患者的临床特征和感染组患者病原菌分布情况,同时对影响患者感染的高危因素进行Logistic回归分析。 结果 感染组患者共计检出84株病原菌,其中革兰阳性球菌20株(23.81%),革兰阴性杆菌60株(71.43%),其他4株(4.76%)。两组患者白细胞水平、尿路梗阻情况、血肌酐水平、尿pH>7.0比例、血尿素氮水平、合并肾积水情况、结石位置、结石直径、抗菌药物使用种类差异均有统计学意义(均P9个/L)、尿pH(>7.0)、血尿素氮(≥7.15 mmol/L)、结石位置(上尿路)、抗菌药物使用种类(≥3种)均为泌尿系统结石合并尿路感染的高危因素,而血肌酐水平,结石直径与泌尿系统结石合并尿路感染无明显相关性。 结论 泌尿系统结石患者易并发尿路感染,其病原菌以革兰阴性杆菌为主。导致尿路感染的因素较多,临床上应提前制定预防措施,降低结石患者尿路感染发生率。     

Rational approach to treatment of patients with polytrauma complicated by urinary tract infection

Development of secondary immune dysbalance in patients with polytrauma complicated by urinary tract infection (acute pyelonephritis) was observed. In such cases bacterial complications were highly possible, that required the use of immunotropic drugs (cycloferon) increasing the host nonspecific resistance, responsible for Th1 immune response. The cycloferon therapy of the patients with chronic pyelonephritis normalized the lymphocyte electrophoretic mobility promoting efficient recovery of the immune homeostasis. Cycloferon was shown to be effective in the prophylaxis and therapy of infective inflammation in the patients with polytrauma, that was evident of the antibacterial therapy efficacy increasing and more rapid healing of the infective inflammation.     

急性肾盂肾炎合并尿路感染危险因素与致病微生物特点的临床分析

目的 探讨急性肾盂肾炎合并尿路感染危险因素与致病微生物的特点。方法 选择2017年4月—2018年4月在本院肾内科就诊的急性肾盂肾炎合并尿路感染患者59例,无菌操作收集患者中段尿,导管收集患者膀胱尿。2 h内送检,采用定量接种的方法,将一定量混匀未离心尿液用接种环接种于血平板或麦康凯平板进行细菌培养。相关性分析采用Pearson相关性检验。结果 糖尿病、肺部感染、尿路结石、脑血管疾病和肿瘤是常见的急性肾盂肾炎（APN）合并尿路感染的危险因素。男性中段尿检出率较高的菌种有大肠埃希菌（E. coli）、金黄色葡萄球菌（S. aureus）等;膀胱尿中检出率较高的菌种有大肠埃希菌（E. coli）、肺炎克雷伯菌（K. pneumoniae）。女性中段尿和膀胱尿中检出率较高的菌种均是大肠埃希菌（E. coli）和金黄色葡萄球菌（S. aureus）。女性总住院时间≥4 d的患者比例明显高于男性。APN患者中合并糖尿病与大肠埃希菌（E. coli）和粪肠球菌（E. faecalis）存在正相关,尿路结石与大肠埃希菌（E. coli）、肺炎克雷伯菌（K. pneumoniae）、屎肠球菌（E. faecium）存在正相关。结论 患者尿液中大肠埃希菌（E. coli）最常见,女性APN患者更容易并发尿路感染,住院时间长于男性患者。合并糖尿病的患者更容易患有大肠埃希菌（E. coli）和粪肠球菌（E. faecalis）感染,合并尿路结石的患者更倾向于大肠埃希菌（E. coli）、肺炎克雷伯菌（K. pneumoniae）、屎肠球菌（E. faecium）感染。     

心功能不全合并下呼吸道感染患者病原菌分布与耐药性分析

目的分析心功能不全合并下呼吸道感染患者的病原菌分布规律及其耐药性特点,以指导临床合理用药。方法采用API系统进行菌种鉴定,采用K-B法进行药敏试验,采用纸片扩散表型确证法进行超广谱β-内酰胺酶(ESBLs)测定。结果 244株病原菌以G-杆菌最多(66.39%),主要是肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌;真菌其次(28.28%),主要是白色假丝酵母菌;G+球菌较少(5.33%),主要是金黄色葡萄球菌。G-杆菌对碳青霉稀类(美罗培南)及氟喹诺酮类(环丙沙星/左氧氟沙星)抗生素较敏感,而对头孢类耐药率较高;白色假丝酵母菌对两性霉素B的耐药率最低。结论心功能不全合并下呼吸道感染患者的主要病原菌以G-杆菌、真菌为主,白色假丝酵母菌是最常见病原菌;病原菌耐药性较强,耐药监测至关重要。