前列腺增生电切术医院感染的病原学特点及影响因素
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摘要
目的为探究前列腺增生电切医院感染的病原学特点及影响因素,为降低临床手术感染率提供依据。方法选取医院2012年1月-2017年1月行经尿道前列腺电切术(TURP)的患者200例作为研究对象,回顾性分析患者的临床资料,探究前列腺增生电切医院感染的病原学特点及影响因素。结果经前列腺增生电切患者发生医院感染共22例,泌尿系统感染18例,占81.82%;共培养病原菌46株,革兰阴性菌38株,占82.61%。患者年龄>65岁、术前行导尿术、手术时间>1.5h、术后留置导尿管时间>3d、合并糖尿病均是导致经前列腺增生电切患者发生医院感染的独立影响因素(P<0.05)。结论导致前列腺增生电切医院感染的影响因素较多,与患者年龄、术前行导尿术、合并症等密切相关,临床需及时对患者评估,了解常见病原菌特点,给予对应性预防对策。
OBJECTIVE To explore the etiological characteristics and influencing factors for nosocomial infection in the patients undergoing the transurethral resection of the prostate(TURP)so as to reduce the incidence of surgical infection.METHODS A total of 200 patients who underwent TURP in the hospital from Jan 2012 to Jan 2017 were recruited as the study objects,the clinical data of the patients were retrospectively analyzed,and the etiological characteristics and influencing factors for nosocomial infection were observed.RESULTS Of the patients who underwent the TURP,22 had nosocomial infection,18(81.82%)of whom had urinary tract infection.Totally 46 strains of pathogens were isolated,38(82.61%)of which were gram-negative bacteria.The more than 65 years of age,preoperative urinary catheterization,operation duration more than 1.5 hours,postoperative catheter indwelling time more than 3 days and complication with diabetes mellitus were the independent influencing factors for the nosocomial infection in the patients undergoing TURP(P<0.05).CONCLUSIONThere are a variety of influencing factors for the nosocomial infection in the patients undergoing TURP,and the nosocomial infection is closely associated with the age,preoperative urinary catheterization and complications.It is necessary for the hospital to assess the patients in a timely manner,understand the etiological characteristics and take targeted prevention measures.
OBJECTIVE To explore the etiological characteristics and influencing factors for nosocomial infection in the patients undergoing the transurethral resection of the prostate(TURP)so as to reduce the incidence of surgical infection.METHODS A total of 200 patients who underwent TURP in the hospital from Jan 2012 to Jan 2017 were recruited as the study objects,the clinical data of the patients were retrospectively analyzed,and the etiological characteristics and influencing factors for nosocomial infection were observed.RESULTS Of the patients who underwent the TURP,22 had nosocomial infection,18(81.82%)of whom had urinary tract infection.Totally 46 strains of pathogens were isolated,38(82.61%)of which were gram-negative bacteria.The more than 65 years of age,preoperative urinary catheterization,operation duration more than 1.5 hours,postoperative catheter indwelling time more than 3 days and complication with diabetes mellitus were the independent influencing factors for the nosocomial infection in the patients undergoing TURP(P<0.05).CONCLUSIONThere are a variety of influencing factors for the nosocomial infection in the patients undergoing TURP,and the nosocomial infection is closely associated with the age,preoperative urinary catheterization and complications.It is necessary for the hospital to assess the patients in a timely manner,understand the etiological characteristics and take targeted prevention measures.
引文
[1]张逸,陈光耀,许新民,等.前列腺切除术后发生尿路感染的因素分析及对策[J].中华医院感染学杂志,2013,23(10):2355-2356,2366.
[2]韦克暖,覃江,黄景智,等.前列腺电切术后泌尿生殖系感染的原因及防治策略[J].医学信息,2013,14(14):590-590.
[3]李云祥,张宗平,王安果,等.索利那新治疗经尿道前列腺电切术后患者膀胱过度活动症的近期疗效[J].中国老年学杂志,2014,34(15):4370-4371.
[4]Leitner L,Sybesma W,Chanishvili N,et al.Bacteriophages for treating urinary tract infections in patients undergoing transurethral resection of the prostate:a randomized,placebo-controlled,double-blind clinical trial[J].BMC Urol,2017,17(1):90.
[5]Sarier M,Duman I,Kilic S,et al.Comparative results of transurethral incision with transurethral resection of the prostate in renal transplant recipients with benign prostate hyperplasia[J].Urol J,2018,15(4):209-213.
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[7]Bausch K,Roth JA,Seifert HH,et al.Overuse of antimicrobial prophylaxis in low-risk patients undergoing transurethral resection of the prostate[J].Swiss Med Wkly,2018,148:w14594.
[8]何国华,包卿兵,张长庚,等.经尿道前列腺电切术治疗前列腺增生症早期疗效的影响因素[J].广东医学,2014,35(22):3521-3523.
[9]ShigemuRa K,Fujisawa M.Current status of holmium laser enucleation of the prostate[J].Int J URol,2018,25(3):206-211.
[10]任晓磊,高志明,夏海波,等.经尿道前列腺电切术联合2μm激光汽化切除术治疗80ml以上BPH的临床研究[J].中华男科学杂志,2015,21(2):136-139.
[11]龙其成,于哲,林光正,等.膀胱造瘘术对于80g以下良性前列腺增生症双极前列腺电切术患者围手术期的临床意义[J].南方医科大学学报,2016,36(1):131-134.
[12]Osman T,ElSaeed KO,Youssef HA,et al.Evaluation of the risk factors associated with the development of post-transurethral resection of the prostate persistent bacteriuria[J].Arab J Urol,2017,15(3):260-266.
[13]Sarier M,Duman i,Demir M,et al.The outcomes of transurethral incision/resection of the prostate(TUIP/TURP)performed early after renal transplantation[J].Turk J Urol,2018,44(2):172-177.
[14]曹会彦,刘智明,乜国雁,等.1470nm半导体激光与等离子经尿道前列腺电切术治疗良性前列腺增生的疗效比较[J].中国老年学杂志,2016,36(19):4849-4851.
[15]Bruyere F,Perennec-Olivie M,Tanguy J,et al.Surgical site infection after trans urethral resection of the prostate(TURP):2008-2013French national SSI surveillance ISO-RAISIN[J].J Infect Prev,2018,19(4):178-183.
[16]Kim SJ,Al Hussein Alawamlh O,Chughtai B,et al.Lower urinary tract symptoms following transurethral resection of prostate[J].Curr Urol Rep,2018,19(10):85-87.
[17]李实,于广海.腹腔镜前列腺癌根治术治疗经尿道前列腺电切术发现的前列腺癌14例临床分析[J].中华男科学杂志,2017,23(10):903-907.
[18]Ivan SJ,Sindhwani P.Comparison of guideline recommendations for antimicrobial prophylaxis in urologic procedures:variability,lack of consensus,and contradictions[J].Int Urol Nephrol,2018,50(11):1923-1937.
[19]董波,刘涛,王立鹤.前列腺电切术后泌尿生殖系感染的危险因素及预防措施[J].中华医院感染学杂志,2014,24(5):1227-1229.
[2]韦克暖,覃江,黄景智,等.前列腺电切术后泌尿生殖系感染的原因及防治策略[J].医学信息,2013,14(14):590-590.
[3]李云祥,张宗平,王安果,等.索利那新治疗经尿道前列腺电切术后患者膀胱过度活动症的近期疗效[J].中国老年学杂志,2014,34(15):4370-4371.
[4]Leitner L,Sybesma W,Chanishvili N,et al.Bacteriophages for treating urinary tract infections in patients undergoing transurethral resection of the prostate:a randomized,placebo-controlled,double-blind clinical trial[J].BMC Urol,2017,17(1):90.
[5]Sarier M,Duman I,Kilic S,et al.Comparative results of transurethral incision with transurethral resection of the prostate in renal transplant recipients with benign prostate hyperplasia[J].Urol J,2018,15(4):209-213.
[6]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.
[7]Bausch K,Roth JA,Seifert HH,et al.Overuse of antimicrobial prophylaxis in low-risk patients undergoing transurethral resection of the prostate[J].Swiss Med Wkly,2018,148:w14594.
[8]何国华,包卿兵,张长庚,等.经尿道前列腺电切术治疗前列腺增生症早期疗效的影响因素[J].广东医学,2014,35(22):3521-3523.
[9]ShigemuRa K,Fujisawa M.Current status of holmium laser enucleation of the prostate[J].Int J URol,2018,25(3):206-211.
[10]任晓磊,高志明,夏海波,等.经尿道前列腺电切术联合2μm激光汽化切除术治疗80ml以上BPH的临床研究[J].中华男科学杂志,2015,21(2):136-139.
[11]龙其成,于哲,林光正,等.膀胱造瘘术对于80g以下良性前列腺增生症双极前列腺电切术患者围手术期的临床意义[J].南方医科大学学报,2016,36(1):131-134.
[12]Osman T,ElSaeed KO,Youssef HA,et al.Evaluation of the risk factors associated with the development of post-transurethral resection of the prostate persistent bacteriuria[J].Arab J Urol,2017,15(3):260-266.
[13]Sarier M,Duman i,Demir M,et al.The outcomes of transurethral incision/resection of the prostate(TUIP/TURP)performed early after renal transplantation[J].Turk J Urol,2018,44(2):172-177.
[14]曹会彦,刘智明,乜国雁,等.1470nm半导体激光与等离子经尿道前列腺电切术治疗良性前列腺增生的疗效比较[J].中国老年学杂志,2016,36(19):4849-4851.
[15]Bruyere F,Perennec-Olivie M,Tanguy J,et al.Surgical site infection after trans urethral resection of the prostate(TURP):2008-2013French national SSI surveillance ISO-RAISIN[J].J Infect Prev,2018,19(4):178-183.
[16]Kim SJ,Al Hussein Alawamlh O,Chughtai B,et al.Lower urinary tract symptoms following transurethral resection of prostate[J].Curr Urol Rep,2018,19(10):85-87.
[17]李实,于广海.腹腔镜前列腺癌根治术治疗经尿道前列腺电切术发现的前列腺癌14例临床分析[J].中华男科学杂志,2017,23(10):903-907.
[18]Ivan SJ,Sindhwani P.Comparison of guideline recommendations for antimicrobial prophylaxis in urologic procedures:variability,lack of consensus,and contradictions[J].Int Urol Nephrol,2018,50(11):1923-1937.
[19]董波,刘涛,王立鹤.前列腺电切术后泌尿生殖系感染的危险因素及预防措施[J].中华医院感染学杂志,2014,24(5):1227-1229.