阿尔茨海默病患者尿路感染的病原学特点及危险因素分析

罗贤海 肖菊艳 陈寿林 邱聪龙 田海华

[關键词] 阿尔茨海默病;尿路感染;病原菌分布;危险因素

[中图分类号] R691.3          [文献标识码] B          [文章编号] 1673-9701（2021）29-0134-04

Etiological characteristics and risk factors for urinary tract infection in patients with Alzheimer's disease

LUO Xianhai1   XIAO Juyan2   CHEN Shoulin1   QIU Conglong2   TIAN Haihua1

1.Department of Laboratory Medicine， Ningbo Kangning Hospital， Ningbo   305201，China; 2.Department of Geriatrics， Ningbo Kangning Hospital， Ningbo   305201，China

[Abstract] Objective To analyze the etiological characteristics and risk factors for Alzheimer′s disease complicated with urinary tract infection， and provide reference for the prevention， control and treatment of urinary tract infection. Methods The infection rate of urinary tract infection in 670 patients with Alzheimer′s disease hospitalized in the Ningbo Kangning Hospital from June 2015 to June 2020 was observed. The clinical characteristics of urinary tract infection in patients with urinary tract infection were observed. The pathogen distribution characteristics were analyzed. Single-and multi-factor regression analyses were conducted to investigate the risk factors for urinary tract infection. Results  There were 156 patients with urinary tract infection， with an infection rate of 23.28%. Urinary tract irritation symptoms， such as frequent urination， urgency， and dysuria， were the main clinical manifestations. A total of 132 pathogens were isolated， most of which were gram-negative bacteria， with 89 strains in total， accounted for 67.42%. Patients′ age， length of hospitalization， combined use of antibiotics， self-care ability， complication of underlying diseases， and indwelling urinary catheter were independent risk factors for Alzheimer′s disease combined with urinary tract infection （P<0.05）. Conclusion Gram-negative bacteria are the main pathogen in patients with Alzheimer′s disease complicated with urinary tract infection. The incidence of urinary tract infection is closely related to patients′ age， long course of disease， complication of serious underlying diseases， self-care ability， indwelling catheterization and other factors. Targeted interventions should be implemented for corresponding risk factors in clinical practice， to improve the efficiency of prevention and treatment of urinary tract infection in patients with Alzheimer′s disease.

[Key words] Alzheimer′s disease; Urinary tract infection; Pathogen distribution; Risk factors

阿尔茨海默病（Alzheimer disease，AD）是一种伴有认知、行为和功能失常的进行性神经变性疾病，由于患者认知力下降，住院时间长、病程长、对自身身体变化感受性差、卫生状况差、生活自理能力低下及伴发基础疾病多等众多特点更增加了医院感染的风险[1-3]。尿路感染是一种常见的医院感染形式，阿尔茨海默病患者合并尿路感染的预防控制工作影响着患者预后和治疗依从性。其感染特点较其他临床科室患者有不同之处，阿尔茨海默病患者合并尿路感染的病原菌分布及危险因素方面的报道不多且研究的病例数较少。本研究回顾性分析2015年6月至2020年6月我院收治的670例阿尔茨海默病患者，对发生尿路感染患者的病原菌分布及危险因素进行分析，以期为临床提供参考，合理选择抗菌药物，为临床预防控制及治疗提供临床依据，现报道如下。

1 资料与方法

1.1 一般资料

选择2015年6月至2020年6月宁波市康宁医院收治的670例年龄≥60岁阿尔茨海默病患者为研究对象，其中男322例，年龄60～95岁，平均（69.8±5.3）岁，病程4～40年，中位数17年;女348例，年齡60～98岁，平均（70.2±5.9）岁;病程3～38年，中位数16年。本研究通过宁波市康宁医院医学伦理委员会批准，入组患者及其家属对本研究均知情同意，并签署知情同意书。全部患者病历资料收集完整，满足统计学要求。

1.1.1 纳入标准  患者均符合美国精神病协会的精神障碍诊断和统计工作手册（DSM-Ⅴ）阿尔茨海默病的诊断标准[4]。……