经直肠超声引导下前列腺穿刺术术后感染的临床特点研究
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摘要
目的分析经直肠超声引导下前列腺穿刺术术后感染的临床特点,并探究其预防对策。方法选择2014年4月至2017年3月于本院就诊的疑似前列腺癌需行前列腺穿刺活检的268例患者作为研究对象,统计患者术后感染发生率和细菌培养鉴定、药敏试验结果,分析患者术后感染的病原学特点和危险因素。结果术后7 d内35例(13.06%)患者出现感染症状,以尿路感染(20例,7.46%)为主,所有术后感染患者均得到有效治疗,未出现死亡案例。35例感染患者均进行了血、尿标本检测,其中34份血标本和33份尿标本细菌培养阳性,67份细菌培养阳性标本中共发现大肠埃希菌59份(88.06%)、脆弱拟杆菌及克雷伯杆菌各4份(5.97%)。药敏试验显示细菌培养阳性样本对喹诺酮类抗菌药物敏感性高。Logistic回归分析显示,合并糖尿病、术前留置导尿管、进行二次穿刺及穿针次数多均为患者行经直肠超声引导下前列腺穿刺术术后感染的危险因素(P_均<0.05)。结论经直肠超声引导下前列腺穿刺术术后感染以大肠埃希菌为主,细菌对喹诺酮类抗菌药物具有较强敏感性。密切关注合并糖尿病、术前留置导尿管患者,适当应用喹诺酮类药物可预防感染发生,同时减少穿针次数、避免二次穿刺对预防患者术后感染具有重要意义。
Objective To study and analyze the clinical features of postoperative infection after transrectal ultrasound-guided transurethral prostatectomy and explore its prevention strategies. Method From April 2014 to March 2017, 268 patients with suspected prostate cancer who needed prostate biopsy were selected as subjects. The incidence of postoperative infection, bacterial culture identification and drug susceptibility test results were analyzed, and the pathogenic characteristics and risk factors of postoperative infection were analyzed. Result Within 7 days after operation, 35 patients(13.06%) showed symptoms of infection,mainly urinary tract infection(20 cases, 7.46%). All patients with postoperative infection were treated effectively and no deaths occurred. The blood samples and urine samples of 35 infected patients were tested. 34 blood samples and 33 urine samples were positive for bacterial culture. A total of 59(88.06%) Escherichia coli, 4(5.97%) Bacteroides fragilis and 4(5.97%) Klebsiella were found in 67 positive bacterial culture specimens. The drug susceptibility test showed that the positive samples of bacterial culture were highly sensitive to quinolones. Logistic regression analysis showed that diabetes mellitus, preoperative indwelling catheter, secondary puncture and needle insertion were all risk factors for postoperative infection in patients undergoing transrectal ultrasound-guided prostate puncture(P_(all)< 0.05). Conclusion After transrectal ultrasound-guided prostate puncture, the main infection is Escherichia coli, and the bacteria has strong sensitivity to quinolone antibiotics. Close attention to patients with diabetes, preoperative indwelling catheters, proper use of quinolones to prevent infection, and reduce the number of needle penetration, avoid the second puncture is also important to prevent postoperative infection.
Objective To study and analyze the clinical features of postoperative infection after transrectal ultrasound-guided transurethral prostatectomy and explore its prevention strategies. Method From April 2014 to March 2017, 268 patients with suspected prostate cancer who needed prostate biopsy were selected as subjects. The incidence of postoperative infection, bacterial culture identification and drug susceptibility test results were analyzed, and the pathogenic characteristics and risk factors of postoperative infection were analyzed. Result Within 7 days after operation, 35 patients(13.06%) showed symptoms of infection,mainly urinary tract infection(20 cases, 7.46%). All patients with postoperative infection were treated effectively and no deaths occurred. The blood samples and urine samples of 35 infected patients were tested. 34 blood samples and 33 urine samples were positive for bacterial culture. A total of 59(88.06%) Escherichia coli, 4(5.97%) Bacteroides fragilis and 4(5.97%) Klebsiella were found in 67 positive bacterial culture specimens. The drug susceptibility test showed that the positive samples of bacterial culture were highly sensitive to quinolones. Logistic regression analysis showed that diabetes mellitus, preoperative indwelling catheter, secondary puncture and needle insertion were all risk factors for postoperative infection in patients undergoing transrectal ultrasound-guided prostate puncture(P_(all)< 0.05). Conclusion After transrectal ultrasound-guided prostate puncture, the main infection is Escherichia coli, and the bacteria has strong sensitivity to quinolone antibiotics. Close attention to patients with diabetes, preoperative indwelling catheters, proper use of quinolones to prevent infection, and reduce the number of needle penetration, avoid the second puncture is also important to prevent postoperative infection.
引文
[1]任明磊,祁克俊,罗福成,等.经直肠超声引导下前列腺穿刺活检并发症原因及预防[J].结直肠肛门外科,2017,23(S1):76-78.
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[5]张志强.经直肠超声引导下前列腺穿刺患者临床特征及生活质量的系列研究[D].合肥:安徽医科大学,2017.
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[10]刘云飞,姜文弟,任冰,等.经直肠超声引导下前列腺穿刺活检并发症分析及处理[J].临床超声医学杂志,2016,18(9):643-645.
[11]万朝晖,刘冰.经直肠超声引导下前列腺穿刺后脊椎感染1例报告[J].现代泌尿外科杂志,2016,21(6):468-469.
[12]Ongün S,Aslan G,Avkan-Oguz V.The effectiveness of singledose fosfomycin as antimicrobial prophylaxis for patients undergo ingtransrectal ultrasound-guided biopsy of the prostate[J].Urol Int,2012,89(4):439-444.
[13]戚庭月,陈亚青,苗华栋,等.经DWI定位经直肠超声引导下前列腺穿刺活检术诊断前列腺癌[J].中国医学影像技术,2011,27(7):1485-1489.
[14]Vasudeva P,Kumar N,Kumar A,et al.Safety of 12 core transrectal ultrasound guided prostate biopsy in patients on aspirin[J].Int Braz J Urol,2015,41(6):1096-1100.
[15]李红星,高宛生,杨彦峰,等.经直肠超声引导下前列腺穿刺活检术后全身炎症反应综合征的危险因素[J].现代泌尿外科杂志,2016,21(5):353-356.
[16]吴萍,杨秀华,夏国兵.经直肠超声引导下前列腺穿刺活检新进展[J].医学综述,2015,21(18):3373-3375.
[17]吴仕吉,邱娅玛,依努尔·吾休尔,等.经直肠超声引导下前列腺穿刺活检的临床分析[J].临床医药文献电子杂志,2015,2(17):3562-3563.
[18]Olshtain-Pops K,Block C,Temper V,et al.An outbreak of achromobacter xylosoxidans associated with ultrasound gel used during transrectal ultrasound guided prostate biopsy[J].JUrol,2011,185(1):144-147.
[19]李虎宜,杨碧云,黄小军,等.经直肠超声引导下前列腺穿刺活检降低诊断感染并发症的临床研究[J].现代泌尿生殖肿瘤杂志,2015,7(2):85-87.
[20]汪骏.经直肠超声引导下前列腺穿刺活检术并发症研究进展[J].现代泌尿外科杂志,2015,20(8):597-600.
[21]Dodds PR,Boucher JD,Shield DE,et al.Are complications of transrectal ultrasound-guided biopsies of the prostate gland increasing?[J].Conn Med,2011,75(8):453-457.
[22]Hillelsohn JH,Duty B,Blute ML,et al.Variability of transrectal ultrasound-guided prostate biopsy prophylactic measures[J].Can J Urol,2012,19(6):6573-6577.
[2]郭申杰.经直肠超声引导下前列腺穿刺活检术后全身炎症反应综合征相关因素分析及护理对策[J].河南外科学杂志,2017,23(6):179-180.
[3]王萌..经直肠超声引导下前列腺穿刺活检105例的临床病理分析[J].中国实用医药,2017,12(30):70-71.
[4]Schoots IG,Roobol MJ,Nieboer D,et al.Magnetic reson ance imaging-targeted biopsy may enhance the diagnostic accuracy of significantprostate cancer detection compared to standard transrectal ultrasound-guided biopsy:a syste matic review and meta-analysis[J].Eur Urol,2015,68(3):438-450.
[5]张志强.经直肠超声引导下前列腺穿刺患者临床特征及生活质量的系列研究[D].合肥:安徽医科大学,2017.
[6]那彦群,叶章群,孙颖浩,等.中国泌尿外科疾病诊断治疗指南(2014版)[M].北京:人民卫生出版社,2013.
[7]王晓岩,许新征,刘洋洋,等.经直肠超声引导下前列腺穿刺活检术的临床运用分析[J].中国地方病防治杂志,2017,32(3):314-317.
[8]Nam RK,Saskin R,Lee Y,et al.Increasing hospital admission rates for urological complications after transrectal ultrasound guided prostate biopsy[J].J Urol,2013,189(1 Suppl):S12-S17,discussion S17-S18.
[9]Novac B,Costache C,Costachescu O,et al.Local periprostatic anest hesia between option and necessity in transrectal ultrasound-guidedprostate biopsy[J].Rev Med Chir Soc Med Nat Iasi,2013,117(1):143-147.
[10]刘云飞,姜文弟,任冰,等.经直肠超声引导下前列腺穿刺活检并发症分析及处理[J].临床超声医学杂志,2016,18(9):643-645.
[11]万朝晖,刘冰.经直肠超声引导下前列腺穿刺后脊椎感染1例报告[J].现代泌尿外科杂志,2016,21(6):468-469.
[12]Ongün S,Aslan G,Avkan-Oguz V.The effectiveness of singledose fosfomycin as antimicrobial prophylaxis for patients undergo ingtransrectal ultrasound-guided biopsy of the prostate[J].Urol Int,2012,89(4):439-444.
[13]戚庭月,陈亚青,苗华栋,等.经DWI定位经直肠超声引导下前列腺穿刺活检术诊断前列腺癌[J].中国医学影像技术,2011,27(7):1485-1489.
[14]Vasudeva P,Kumar N,Kumar A,et al.Safety of 12 core transrectal ultrasound guided prostate biopsy in patients on aspirin[J].Int Braz J Urol,2015,41(6):1096-1100.
[15]李红星,高宛生,杨彦峰,等.经直肠超声引导下前列腺穿刺活检术后全身炎症反应综合征的危险因素[J].现代泌尿外科杂志,2016,21(5):353-356.
[16]吴萍,杨秀华,夏国兵.经直肠超声引导下前列腺穿刺活检新进展[J].医学综述,2015,21(18):3373-3375.
[17]吴仕吉,邱娅玛,依努尔·吾休尔,等.经直肠超声引导下前列腺穿刺活检的临床分析[J].临床医药文献电子杂志,2015,2(17):3562-3563.
[18]Olshtain-Pops K,Block C,Temper V,et al.An outbreak of achromobacter xylosoxidans associated with ultrasound gel used during transrectal ultrasound guided prostate biopsy[J].JUrol,2011,185(1):144-147.
[19]李虎宜,杨碧云,黄小军,等.经直肠超声引导下前列腺穿刺活检降低诊断感染并发症的临床研究[J].现代泌尿生殖肿瘤杂志,2015,7(2):85-87.
[20]汪骏.经直肠超声引导下前列腺穿刺活检术并发症研究进展[J].现代泌尿外科杂志,2015,20(8):597-600.
[21]Dodds PR,Boucher JD,Shield DE,et al.Are complications of transrectal ultrasound-guided biopsies of the prostate gland increasing?[J].Conn Med,2011,75(8):453-457.
[22]Hillelsohn JH,Duty B,Blute ML,et al.Variability of transrectal ultrasound-guided prostate biopsy prophylactic measures[J].Can J Urol,2012,19(6):6573-6577.