输尿管支架细菌生物膜观察及病原菌分布和耐药性

Abstract BACKGROUND: Ureteral stents have been extensively applied in the stenosis in the conjunction of the renal pelvis and ureter, the reconstruction of in situ urine flow, ureter or nephroscope lithotripsy, renal transplant, and tumors. However, the long-term retention of ureteral stents can induce catheter-associated urinary tract infection complications. OBJECTIVE: To investigate the morphological characteristics of bacterial biofilm on ureteral stent, and to analyze the features of pathogenic distribution and antimicrobial drug resistance to bacterial biofilm. METHODS: Specimens of ureteral stent were collected from 127 patients at Yongchuan Hospital, Chongqing Medical University between January and December 2016. The morphological characteristics of bacterial biofilm on the stent were observed under scanning electron microscope. Each specimen was divided into three parts (renal pelvis, ureter and bladder) for screening biofilm-forming bacteria strains separately by Congo red medium. The urine was bacterially cultured. Drug susceptibility test was done with the collected biofilm-forming bacteria strains. The study was approved by the Ethics Committee of Yongchuan Hospital, Chongqing Medical University (approval No. 201422). RESULTS AND CONCLUSION: (1) Bacterial biofilm was observed on the surface of ureteral stents at 7, 15 and 30 days of retention, with various numbers of inflammatory attachments or crystals. Bacteria on the bacterial biofilm were embraced by large amounts of fiber membranes. Patchy bacterial colonies were observed on the surface of the ureteral stent at 7 and 15 days of retention, which mainly focused on bacillus. Heap-shaped bacterial colonies were found on the surface of ureteral stents that were retained for 30 days, which mainly were bacillus and coccus. (2) A total of 106 bacterial biofilms were detected in the ureteral stent samples obtained from 127 patients. The positive rate was 83.5%, in which the bladder section had the highest positive rate, followed by the renal pelvis section and ureter section. There were 25 copies of positive urine culture, and the positive rate was 19.7%. The strains obtained from the bacterial biofilm on each section of the ureteral stents were significantly higher than that from the urine bacteria culture (P < 0.05). (3) A total of 227 strains were detected from 106 positive samples. Among these samples, the number of Gram-negative strains was significantly higher than that of Gram-positive strains (P < 0.05). Among culture bacteria of the bacterial biofilm on the ureteral stent and urine culture bacteria, colibacillus, pseudomonas aeruginosa, enterococcus faecalis and enterococcus faecium were the most common. (4) The biofilm-forming bacteria on the ureteral stent had a high drug resistance. (5) In summary, bacterial biofilm may be the important reason for catheter-associated urinary tract infection. Key words: bacterial biofilm; ureteral stent; catheter-associated urinary tract infection; drug resistance; nosocomial infections; urine culture; colibacillus; pseudomonas aeruginosa Funding: the Medical Research Project of Health and Family Planning Commission of Chongqing, No. 20142062 (to ZJM)
Zhang Jiamo, Master, Attending physician, Department of Urology, Yongchuan Hospital, Chongqing Medical University, Chongqing 402160, China
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ZHANG JM, ZHANG X, LUO HM, ZHAO T, CHEN JC, LIU J, WANG K. Pathogenic distribution and drug resistance of bacterial biofilm on ureteral stent. Zhongguo Zuzhi Gongcheng Yanjiu. 2020;24(16):2556-2560. DOI:10.3969/j.issn.2095-4344.2267
摘要 背景：输尿管支架被广泛用于肾盂输尿管交界处狭窄、原位尿流改道重建、输尿管或肾镜碎石、肾移植和肿 瘤等泌尿系疾病，但长期留置输尿管支架可导致导管相关性尿路感染等并发症。 目的：观察输尿管支架表面细菌生物膜的形态学特点，分析细菌生物膜的病原学分布特征及耐药性。 方法：收集 2016 年 1 至 12 月重庆医科大学附属永川医院 127 例患者的输尿管支架标本，扫描电镜观察支架 表面细菌生物膜的形态学特征，刚果红培养基分别筛选肾盂段、输尿管段和膀胱段支架的细菌生物膜菌株， 同时进行尿培养，对检出的病原菌进行药敏试验分析。实验获得重庆医科大学附属永川医院伦理委员会批准， 批准号：2014 年科伦审 22 号。 结果与结论：①在留置 7，15，30 d 的输尿管支架表面均能够观察到细菌生物膜及数量不等的炎性附着物或 结晶体，细菌生物膜的细菌被大量纤维膜包裹；留置 7，15 d 的输尿管支架表面可见呈片状散在分布的菌落， 以杆菌为主；留置 30 d 的输尿管支架表面可见呈堆状分布的菌落，以球菌、杆菌为主；②127 份输尿管支架 标本中检出细菌生物膜 106 份，阳性率为 83.5%，其中膀胱段阳性率最高，其次为肾盂段和输尿管段；尿培 养阳性为 25 份，阳性率为 19.7%，尿液培养的细菌生物膜阳性率明显低于输尿管支架培养结果(P < 0.05)； ③106 份阳性标本中检出细菌 227 株，其中革兰阴性菌株数显著高于革兰阳性菌株数(P < 0.05)；输尿管支架 细菌生物膜和尿培养细菌均主要以大肠杆菌、铜绿假单胞菌、粪肠球菌和屎肠球菌最为常见；④输尿管支架 管表面细菌生物膜菌株的耐药率高；⑤结果表明输尿管支架细菌生物膜是诱发导管相关性尿路感染的重要因 素。 关键词： 细菌生物膜；输尿管支架；导管相关感染；耐药性；医源性感染；尿培养；大肠杆菌；铜绿假单胞菌 中图分类号：R459.9；R378；R318 基金资助： 重庆市卫生计生委医学科研项目(20142062)，项目负责人：张家模
402160)
DOI:10.3969/j.issn.2095-4344.2267
ORCID: 0000-0001-9204-7321(张家模)
文章快速阅读：
文章特点—
(1)研究发现输尿管支架表面细菌生物膜的形成在导管相关性尿路感染中起着重要作用，细菌黏附在 输尿管支架形成生物膜后具有很强的耐药性；
(2)全面分析输尿管支架表面细菌生物膜的形态学特点、病原菌费分布和耐药性。
《中国组织工程研究》 Chinese Journal of Tissue Engineering ReFra Baidu bibliotekearch
输尿管支架细菌生物膜观察及病原菌分布和耐药性
·研究原著·
张家模1，张 翾1，罗华铭1，赵 涛1，陈江川1，刘 娟2，王 科3(重庆医科大学附属永川医院，1泌尿科，2药剂科，3检验科，重庆市
文献标识码:A 投稿日期：2019-09-03 送审日期：2019-09-05 采用日期：2019-10-31 在线日期：2019-12-30
文题释义： 细菌生物膜：细菌及其细胞外产物在载体表面聚集形成的一种有序群落，其主要成分为多糖蛋白复合物，是 多种细菌相互粘连而产生得具有特定结构的细菌复合体。细菌生物膜分 3 层：连接膜附着于组织或生物材料 表面；基底膜包含致密的菌群；表面膜为最外层，浮游菌可从其表面被释放后自由飘浮和播散。微菌落是生 物膜的基本结构单位，微菌落相互融合连接形成大片均一的生物膜。 导管相关性尿路感染：导尿管相关尿路感染主要是指患者留置导尿管后或者拔除导尿管 48 h 内发生的泌尿系 统感染。
扫描电镜：
结论：
获取 127 例 患者的输尿 管支架标本
观察支架表面细菌生物膜的形态学特征； 刚果红培养基：
筛选肾盂段、输尿管段和膀胱段支架的细 菌生物膜菌株；
输尿管支架细菌 生物膜是诱发导 管相关性尿路感 染的重要因素。
尿培养：
对检出的病原菌进行药敏试验分析。
张家模，男，1982 年生， 重庆市人，汉族，硕士， 主治医师，主要从事泌尿 系结石微创治疗方面的研 究。
Pathogenic distribution and drug resistance of bacterial biofilm on ureteral stent
Zhang Jiamo1, Zhang Xuan1, Luo Huaming1, Zhao Tao1, Chen Jiangchuan1, Liu Juan2, Wang Ke3 (1Department of Urology, 2Department of Pharmacy, 3Department of Laboratory Medicine, Yongchuan Hospital, Chongqing Medical University, Chongqing 402160, China)