中国真菌学杂志2025，Vol.20Issue(5)：466-471,6.DOI:10.3969/j.issn.1673-3827.2025.05.004
2型糖尿病患者念珠菌尿路感染合并产超广谱β-内酰胺酶菌株感染的危险因素分析
Risk factors for ESBL-producing strain infection in type 2 diabetes mellitus patients complicated with Candidaurinary tract in-fection
摘要
Abstract
Objective To explore the clinical characteristics and independent risk factors of extended-spectrum β-lac-tamase(ESBLs)infection in patients with type 2 diabetes mellitus(T2DM)complicated by Candida urinary tract infec-tion,so as to provide a basis for accurate clinical prevention and treatment.Methods A retrospective analysis was per-formed on the clinical data of 119 T2DM patients with urinary tract infection admitted to Fuyang Hospital Affiliated to An-hui Medical University from January 2020 to March 2024.According to the infection type,patients were divided into ES-BLs+Candida infection group(study group,n=60)and Candida alone infection group(control group,n=59).The clinical characteristics,pathogen distribution and drug sensitivity results were compared between the two groups.Univari-ate analysis and multivariate logistic regression were used to screen independent risk factors for combined infection,and a risk prediction model was constructed.Results The comparison of baseline data between the study group and the control group showed that there were no statistically significant differences in age[study group:(64.1±7.9)years old,control group:(63.5±8.2)years old],gender ratio,diabetes duration[study group:(11.6±4.2)years,control group:(10.7±3.9)years],and body mass index[study group:(24.7±2.1)kg/m2,control group:(24.5±2.3)kg/m2](P values were 0.681,0.850,0.307,0.598,respectively).Among 119 patients,Candida albicans was the main pathogen(68.1%),and ESBL-producing strains in the study group were mainly Escherichia coli(86.7%).Fasting blood glucose[(10.7±2.3)mmol/L vs.(8.5±1.9)mmol/L]and systolic blood pressure[(136.8±10.5)mmHg vs.(128.3±9.7)mmHg]in the study group were significantly higher than those in the control group(P<0.05),while 25-hydroxyvitamin D[(31.8±6.5)nmol/L vs.(42.3±7.1)nmol/L]was significantly lower(P<0.05).The proportions of diabetic peripheral neu-ropathy(85.0%vs.64.4%),neurogenic bladder(30.0%vs.10.2%)and broad-spectrum antibiotic use≥14 days(70.0%vs.42.4%)in the study group were significantly higher than those in the control group(P<0.05).The study group showed significantly higher values than the control group in the following parameters:white blood cell count[(11.2±3.5)×109/L vs(7.8±2.1)×109/L],neutrophil percentage(76.5%vs.62.3%)and 76.5%,hematogenous infec-tion rate(20.0%vs.5.1%),pyelonephritis incidence(41.7%vs.16.9%),urinary tract stone occurrence(25.0%vs.8.5%),and prior history of urological malignancy(13.3%vs.3.4%)(P<0.05).The resistance rate of Candida to flu-conazole was 15.1%,with no significant difference between the two groups(P>0.05).Multivariate logistic regression showed that elevated fasting blood glucose(OR=1.382,95%CI=1.126-1.695),combined neurogenic bladder(OR=16.735,95%CI=5.218-53.642),25-hydroxyvitamin D reduction(OR=1.258,95%CI=0.915-0.980)and urinary stones(OR=3.215,95%CI=1.236-8.367)were independent risk factors for combined infection.The area under the ROC curve of the risk prediction model based on the above factors was 0.792(95%CI=0.615-0.869),with a sensitivity of 85.0%and specificity of 83.1%.Conclusion In T2DM patients with urinary tract infection,ESBL-producing strains combined with Candida infection are closely related to poor blood glucose control,neurogenic bladder and vitamin D defi-ciency.Clinical targeted intervention should be taken to reduce the infection risk.关键词
2型糖尿病/尿路感染/产超广谱β-内酰胺酶菌株/念珠菌/危险因素Key words
type 2 diabetes mellitus/urinary tract infection/ESBL-producing strains/Candida/risk factors引用本文复制引用
郝娜娜,余本富,刘永菊..2型糖尿病患者念珠菌尿路感染合并产超广谱β-内酰胺酶菌株感染的危险因素分析[J].中国真菌学杂志,2025,20(5):466-471,6.基金项目
安徽省高校科研项目(2024AH050667) （2024AH050667）
