多发肾结石患者微创经皮肾镜取石术后感染耐药菌与药敏分析
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摘要
目的探讨多发肾结石患者微创经皮肾镜取石术后感染病原菌与药物敏感性。方法回顾性分析2006年1月-2017年4月于医院就诊的多发肾结石患者1 400例的临床资料,均行微创经皮肾镜取石术治疗,根据术后感染情况分为感染组394例和未感染组1 006例;分析感染病原菌与药物敏感性及肌酐(Serum creatinine,Scr)、尿素氮(Blood urea nitrogen,BUN)、超氧化物歧化酶(Superoxide Dismutase,SOD)、丙二醛(Malondialdehyde,MDA),血清氧化应激因子和微量尿蛋白情况。结果多发肾结石患者微创经皮肾镜取石术后感染率为28.14%(394/1400);感染组患者Scr、BUN、微量尿蛋白与MDA分别为(123.15±8.94)μmol/L、(12.46±3.18)mmol/L、(29.81±4.12)mg/L、(33.81±6.15)mmol/L,高于非感染患者(P<0.001),而血清SOD为(401.23±15.79)U/L低于非感染组(P <0.05);氧化应激蛋白NOX2、NOX4、DUOX1分别为(0.61±0.12)mmol/L、(0.62±0.18)mmol/L、(0.59±0.20)mmol/L高于非感染组(P<0.001);394例感染患者共培养分离病原菌408株,其中革兰阳性菌176株占43.14%,以金黄色葡萄球菌、屎肠球菌为主;革兰阴性菌222株占54.41%,以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌为主;真菌10株占2.45%;主要革兰阳性菌对万古霉素和利奈唑胺敏感,对青霉素耐药率较高;主要革兰阴性菌对青霉素类抗菌药物耐药率较高,对亚胺培南较敏感。结论多发肾结石患者微创经皮肾镜取石术后感染率较高,术后加强监管预防,可有效降低术后感染发生率,提升其预后效果,具有一定的临床意义。
OBJECTIVE To investigate the drug susceptibility of drug-resistant bacteria causing postoperative infection in patients with multiple nephrolithiasis after minimally invasive percutaneous nephrolithotomy.METHODS The clinical data of 1400 patients with multiple nephrolithiasis who were referred to our hospital from Jan.2006 to Apr.2017 were retrospectively analyzed.According to occurrence of postoperative infection,they were divided into infected group(394 cases)and noninfected group(1006 cases).All of the 1400 patients underwent minimally invasive percutaneous nephrolithotomy,of which 394 patients had varying degrees of postoperative infection.The incidence of postoperative infection was calculated and the infecting pathogens,drug sensitivity,serum creatinine(Scr),blood nitrogen(BUN),superoxide dismutase(SOD),malondialdehyde(MDA),serum oxidative stress factors and trace urine proteins were analyzed.RESULTS The incidence of postoperative infection was 28.14%(394/1400)in patients with multiple nephrolithiasis after minimally invasive percutaneous nephrolithotomy.And the levels of creatinine(123.15±8.94μmol/L),blood urea nitrogen(12.46±3.18 mmol/L),microalbuminuria(29.81±4.12 mg/L)and MDA(33.81±6.15 mmol/L)were significantly higher in patients with infection after percutaneous nephrolithotomy than those in non-infected patients(P<0.001).The levels of serum SOD(401.23±15.79 U/L)in postoperative infection patients were significantly lower than those in non-infected patients(P<0.05).The levels of NOX2(0.61±0.12 mmol/L),NOX4(0.62±0.18 mmol/L)and DUOX1(0.59±0.20 mmol/L)were significantly higher in infected group than those in non-infected group(P<0.001).A total of 408 strains of pathogens were detected in the 394 infected patients,of which 176 strains were gram-positive bacteria(43.14%),mainly Staphylococcus aureus,Enterococcus,and Streptococcus pneumoniae;222 strains(54.41%)were gram-negative bacteria,mainly Escherichia coli,Klebsiella pneumoniae,and Pseudomonas aeruginosa;and10 strains(2.45%)were fungi,all of which were Candida albicans.The main gram-positive bacteria were sensitive to vancomycin and linezolid,and had a higher resistance rate to penicillin.The main gram-negative bacteria had a higher resistance rate to penicillin,but they were relatively sensitive to imipenem.CONCLUSION Patients with multiple nephrolithiasis have a higher probability of infection after minimally invasive percutaneous nephrolithotomy,and positive postoperative surveillance and prevention would help to effectively reduce the morbidity and improve prognosis of the patients with multiple nephrolithiasis,and therefore has the clinical promotion value.
OBJECTIVE To investigate the drug susceptibility of drug-resistant bacteria causing postoperative infection in patients with multiple nephrolithiasis after minimally invasive percutaneous nephrolithotomy.METHODS The clinical data of 1400 patients with multiple nephrolithiasis who were referred to our hospital from Jan.2006 to Apr.2017 were retrospectively analyzed.According to occurrence of postoperative infection,they were divided into infected group(394 cases)and noninfected group(1006 cases).All of the 1400 patients underwent minimally invasive percutaneous nephrolithotomy,of which 394 patients had varying degrees of postoperative infection.The incidence of postoperative infection was calculated and the infecting pathogens,drug sensitivity,serum creatinine(Scr),blood nitrogen(BUN),superoxide dismutase(SOD),malondialdehyde(MDA),serum oxidative stress factors and trace urine proteins were analyzed.RESULTS The incidence of postoperative infection was 28.14%(394/1400)in patients with multiple nephrolithiasis after minimally invasive percutaneous nephrolithotomy.And the levels of creatinine(123.15±8.94μmol/L),blood urea nitrogen(12.46±3.18 mmol/L),microalbuminuria(29.81±4.12 mg/L)and MDA(33.81±6.15 mmol/L)were significantly higher in patients with infection after percutaneous nephrolithotomy than those in non-infected patients(P<0.001).The levels of serum SOD(401.23±15.79 U/L)in postoperative infection patients were significantly lower than those in non-infected patients(P<0.05).The levels of NOX2(0.61±0.12 mmol/L),NOX4(0.62±0.18 mmol/L)and DUOX1(0.59±0.20 mmol/L)were significantly higher in infected group than those in non-infected group(P<0.001).A total of 408 strains of pathogens were detected in the 394 infected patients,of which 176 strains were gram-positive bacteria(43.14%),mainly Staphylococcus aureus,Enterococcus,and Streptococcus pneumoniae;222 strains(54.41%)were gram-negative bacteria,mainly Escherichia coli,Klebsiella pneumoniae,and Pseudomonas aeruginosa;and10 strains(2.45%)were fungi,all of which were Candida albicans.The main gram-positive bacteria were sensitive to vancomycin and linezolid,and had a higher resistance rate to penicillin.The main gram-negative bacteria had a higher resistance rate to penicillin,but they were relatively sensitive to imipenem.CONCLUSION Patients with multiple nephrolithiasis have a higher probability of infection after minimally invasive percutaneous nephrolithotomy,and positive postoperative surveillance and prevention would help to effectively reduce the morbidity and improve prognosis of the patients with multiple nephrolithiasis,and therefore has the clinical promotion value.
引文
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[14]季武,杨秀书,李荣富,等.陈勇肾结石患者经皮肾镜取石术后重症感染病原菌与对肾功能影响机制研究[J].中华医院感染学杂志,2015,25(20):4621-4623.
[15]Kaneko K,Tsuji S,Kimata T,et al.Pathogenesis of childhood idiopathic nephrotic syndrome:aparadigm shift from T-cells to podocytes[J].World J Pediatr,2015,11(1):21-28.
[16]Martins N,Ferreira IC,Barros L,et al.Candidiasis:predisposing factors,prevention,diagnosis and alternative treatment[J].Mycopathologia,2014,177(5-6):223-240.
[17]Guo W,Liu Y,Han W,et al.Randomized trial of immediate postoperative pain following single-incision versus traditional laparoscopic cholecystectomy[J].Chin Med J(Engl),2015,128(24):3310-3316.
[18]王鑫,崔向丽,杨辉,等.肾移植术后医院感染病原菌及抗感染治疗方案分析[J].药学与临床研究,2016,24(6):475-478.
[19]Zhang S,Huang W.Epidemiological study of communityand hospital-acquired intraabdominal infections[J].Chin JTraumatol,2015,18(2):84-89.
[20]韩兴涛,魏鹏涛,张寒,等.孤立肾肾结石患者经皮肾镜取石术后感染性休克的病原学分析[J].中华医院感染学杂志,2015,25(2):393-395.
[21]纪翠雅,林学慧,文智,等.输尿管上段结石微创治疗术后医院感染的临床分析[J].中华医院感染学杂志,2015,25(17):4006-4008.
[2]张春云,张艳红,高彦,等.经皮肾镜碎石患者术后感染的临床分析[J].中华医院感染学杂志,2016,26(11):2550-2552.
[3]俞云松,杜小幸.外科感染细菌耐药特点与抗感染药物选择[J].中国实用外科杂志,2016,36(2):155-157.
[4]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[5]Tiselius HG1,Ackermann D,Alken P,et al.Guidelines on urolithiasis.Eur Urol.2001,40(4):362-371.
[6]王斌,陶佳意,汪兴旺,等.肾结石患者术后泌尿系感染与结石复发的相关因素分析[J].中华医院感染学杂志,2016,26(13):3026-3027.
[7]Xiong LL,Huang XB,Ye XJ,et al.Application of a novel intracorporeal combined pneumatic and ultrasonic lithotriptor(CQS-01)in percutaneous nephrolithotomy[J].Beijing Da Xue Xue Bao Yi Xue Ban.2012,44(4):575-578.
[8]朱清,姜红芬,马菊,等.输尿管上段嵌顿结石合并感染的病原菌分析与治疗[J].中华医院感染学杂志,2016,26(10):2311-2313.
[9]乔明洲,张海芳,周晨龙.肾结石患者经皮肾镜碎石术后结石残留影响因素分析[J].中华医学杂志,2015,95(44):3617-3619.
[10]于汝通,孙国良,陈志强,等.肾结石患者不同碎石术后感染比较[J].中华医院感染学杂志,2015,25(16):3766-3767.
[11]Shafi H,Ilkhani M,Darabi Ahangar Z,et al.Antibiotic prophylaxis in the prevention of urinary tract infection in patients with sterile urine before extracorporeal shock wave lithotripsy[J].Caspian J Intern Med,2018,9(3):296-298.
[12]Shen J,Sun F,Chen FM,et al.Therapy and prevention of postoperative urosepsis of ureter endoscopic lithotripsy for non-infection[J].Chin Med Sci J,2016,31(1):49-53.
[13]洪涛,柯莽,俞洪元,等.不同口径通道对经皮肾镜取石手术患者术后感染的影响[J].中华医院感染学杂志,2017,27(7):1568-1571.
[14]季武,杨秀书,李荣富,等.陈勇肾结石患者经皮肾镜取石术后重症感染病原菌与对肾功能影响机制研究[J].中华医院感染学杂志,2015,25(20):4621-4623.
[15]Kaneko K,Tsuji S,Kimata T,et al.Pathogenesis of childhood idiopathic nephrotic syndrome:aparadigm shift from T-cells to podocytes[J].World J Pediatr,2015,11(1):21-28.
[16]Martins N,Ferreira IC,Barros L,et al.Candidiasis:predisposing factors,prevention,diagnosis and alternative treatment[J].Mycopathologia,2014,177(5-6):223-240.
[17]Guo W,Liu Y,Han W,et al.Randomized trial of immediate postoperative pain following single-incision versus traditional laparoscopic cholecystectomy[J].Chin Med J(Engl),2015,128(24):3310-3316.
[18]王鑫,崔向丽,杨辉,等.肾移植术后医院感染病原菌及抗感染治疗方案分析[J].药学与临床研究,2016,24(6):475-478.
[19]Zhang S,Huang W.Epidemiological study of communityand hospital-acquired intraabdominal infections[J].Chin JTraumatol,2015,18(2):84-89.
[20]韩兴涛,魏鹏涛,张寒,等.孤立肾肾结石患者经皮肾镜取石术后感染性休克的病原学分析[J].中华医院感染学杂志,2015,25(2):393-395.
[21]纪翠雅,林学慧,文智,等.输尿管上段结石微创治疗术后医院感染的临床分析[J].中华医院感染学杂志,2015,25(17):4006-4008.