肾结石患者经皮肾镜取石术后泌尿系感染的病原学特点及影响因素分析
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摘要
目的探讨肾结石患者经皮肾镜取石术后泌尿系感染的病原学特征及影响因素分析,为降低感染提供依据。方法回顾性分析2014年6月-2017年6月医院泌尿外科收治的485例经皮肾镜取石术肾结石患者的临床资料,统计泌尿系感染患者病原菌分布及耐药性,单因素及多因素logistic回归分析发生医院感染的影响因素。结果 485例患者共发生泌尿系感染65例,感染率为13.40%。分离出88株病原菌,革兰阴性菌56株占63.64%、革兰阳性菌30株占34.09%、真菌2株占2.27%。主要革兰阴性菌大肠埃希菌对氨苄西林和甲氧苄啶耐药率均>70.00%,肺炎克雷伯菌对甲氧苄啶、头孢唑林、庆大霉素及四环素耐药率>60.00%,两种病原菌均未检出亚胺培南耐药菌株,主要革兰阳性菌屎肠球菌和粪肠球菌均对青霉素耐药率最高,分别为84.62%和90.91%,对万古霉素耐药率最低均为0.00%;多元Logistic回归分析显示,高龄、合并糖尿病,术前尿WBC满视野(+++)为PCNL术后发生泌尿系感染的独立影响因素。结论针对影响因素,加强监控,预防感染,对已发生感染患者,根据病原菌及药敏试验,合理应用抗菌药物。
OBJECTIVE To explore the etiological characteristics and influencing factors for postoperative urinary tract infection in renal calculi patients undergoing percutaneous nephrolithotomy so as to reduce the incidence of infection.METHODS The clinical data of 485 renal calculi patients who underwent the percutaneous nephrolithotomy in urology department from Jun 2014 to Jun 2017 were retrospectively analyzed,the distribution and drug resistance rats of the pathogens causing the urinary tract infection were statistically analyzed,and the univariate analysis and multivariate logistic regression analysis were performed for the influencing factors for the nosocomial infection.RESULTS Of the 485 patients,totally 65 had urinary tract infection,with the infection rate 13.40%.A total of 88 strains of pathogens were isolated,56(63.64%)of which were gram-negative bacteria,30(34.09%)were grampositive bacteria,and 2(2.27%)were fungi.The drug resistance rates of the major species of gram-negative bacteria Escherichia coli to ampicillin and trimethoprim were more than 70.00%,the drug resistance rates of Klebsiella pneumoniae strains to trimethoprim,cefazolin,gentamicin and tetracycline were more than 60.00%,and no strains of the two species of pathogens were detected to be resistant to imipenem.The drug resistance rates of the major species of gram-positive bacteria Enterococcus faeciumand Enterococcus faecalis to penicillin were 84.62%and 90.91%,respectively,while the drug resistance rates to vancomycin were 0.The multivariate logistic regression analysis showed that the advanced age,complication with diabetes mellitus and preoperative urine WBC with full field vision of(+++)were the independent influencing factors for the postoperative urinary tract infection in the patients undergoing the percutaneous nephrolithotomy.CONCLUSIONIt is necessary to strengthen the monitoring according to the influencing factors,prevent the infection and use antibiotics based on the result of drug susceptibility testing.
OBJECTIVE To explore the etiological characteristics and influencing factors for postoperative urinary tract infection in renal calculi patients undergoing percutaneous nephrolithotomy so as to reduce the incidence of infection.METHODS The clinical data of 485 renal calculi patients who underwent the percutaneous nephrolithotomy in urology department from Jun 2014 to Jun 2017 were retrospectively analyzed,the distribution and drug resistance rats of the pathogens causing the urinary tract infection were statistically analyzed,and the univariate analysis and multivariate logistic regression analysis were performed for the influencing factors for the nosocomial infection.RESULTS Of the 485 patients,totally 65 had urinary tract infection,with the infection rate 13.40%.A total of 88 strains of pathogens were isolated,56(63.64%)of which were gram-negative bacteria,30(34.09%)were grampositive bacteria,and 2(2.27%)were fungi.The drug resistance rates of the major species of gram-negative bacteria Escherichia coli to ampicillin and trimethoprim were more than 70.00%,the drug resistance rates of Klebsiella pneumoniae strains to trimethoprim,cefazolin,gentamicin and tetracycline were more than 60.00%,and no strains of the two species of pathogens were detected to be resistant to imipenem.The drug resistance rates of the major species of gram-positive bacteria Enterococcus faeciumand Enterococcus faecalis to penicillin were 84.62%and 90.91%,respectively,while the drug resistance rates to vancomycin were 0.The multivariate logistic regression analysis showed that the advanced age,complication with diabetes mellitus and preoperative urine WBC with full field vision of(+++)were the independent influencing factors for the postoperative urinary tract infection in the patients undergoing the percutaneous nephrolithotomy.CONCLUSIONIt is necessary to strengthen the monitoring according to the influencing factors,prevent the infection and use antibiotics based on the result of drug susceptibility testing.
引文
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[12]杨俊梅.肾结石患者经皮肾镜碎石取石术后常见并发症分析及护理对策[J].临床合理用药杂志,2017,10(15):154-155.
[2]中华人民共和国卫生部.医院感染诊断标准[J].中华医学杂志,2001,81(5):314-320.
[3]严泉江,潘华锋,干雪峰,等.肾结石患者术后泌尿系感染的病原学特点及危险因素研究[J].中华医院感染学杂志,2017,27(22):5168-5171.
[4]尚红,王毓三,申子瑜.全国临床检验操作规程[M].4版.北京:人民卫生出版社,2014:635-670.
[5]Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing:twenty-first informational supplement[S].Wayne,PA:CLSI,2012.
[6]李江,陈勇,邹庆波.肾结石患者尿路感染病原菌分布与耐药性分析[J].中华医院感染学杂志,2015,25(17):3881-3883.
[7]Walton-Diaz A,Vinay JI,Barahona J,et al.Concordance of renal stone culture:PMUC,RPUC,RSC and post-PCNL sepsis-a non-randomized prospective observation cohort study[J].Int Urol Nephrol,2017,49(1):31-35.
[8]孙翔,习海波.经皮肾镜取石术治疗老年肾结石患者出血的危险因素[J].中国老年学杂志,2016,36(11):2708-2709.
[9]尚向涛,仵亚迪.尿石症并发尿路感染的危险因素和病原学分析[J].中国医学前沿杂志(电子版),2017,9(9):87-91.
[10]范钧泓,吴文起,朱玮,等.经皮肾镜取石术后全身炎症反应综合征的相关危险因素分析[J].中华泌尿外科杂志,2017,38(11):857-861.
[11]严世英,史南,林明霞.经皮肾镜碎石术后患者感染的预防控制[J].中华医院感染学杂志,2014,24(13):3296-3298.
[12]杨俊梅.肾结石患者经皮肾镜碎石取石术后常见并发症分析及护理对策[J].临床合理用药杂志,2017,10(15):154-155.