上尿路结石患者内镜碎石术后泌尿系统感染的临床分析
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摘要
目的分析上尿路结石患者内镜碎石术后泌尿系统感染的病原菌分布,以指导上尿路结石患者术后抗菌药物的预防使用。方法回顾性分析2011年2月-2015年3月682例行内镜碎石术的上尿路结石患者临床资料,统计其术后泌尿系统感染率、病原菌分布及耐药率,数据采用SPSS13.0软件进行处理。结果 682例上尿路结石患者行内镜碎石术后发生泌尿系统感染33例,感染率为4.8%,发生重症感染11例、感染性休克4例,发生率分别为1.6%、0.6%;共分离病原菌72株,其中革兰阴性菌51株占70.8%,革兰阳性菌20例占27.8%,主要病原菌为大肠埃希菌占30.5%;主要革兰阴性菌对头孢呋辛、阿莫西林、阿米卡星和亚胺培南等抗菌药物较敏感,耐药率为0~45.5%,对头孢唑林、头孢曲松和氨苄西林等高度耐药,耐药率为54.5%~100.0%;主要革兰阳性菌对万古霉素、替考拉宁和氧氟沙星较敏感,耐药率为0~28.6%,对青霉素G、庆大霉素和红霉素等高度耐药,耐药率为71.4%~100.0%。结论上尿路结石患者行内镜碎石术后泌尿系统感染率较高,感染病原菌主要为大肠埃希菌,临床应加强病原菌监测,参考病原菌耐药谱,合理选用抗菌药物。
OBJECTIVE To investigate the urinary system infections in patients treating with endoscopic lithotripsy so as to guide the prevention and application of antibiotics on patients with upper urinary calculi.METHODS The clinical data of 682 patients treating with endoscopic lithotripsy in hospital from Feb.2011 to Mar.2015 were analyzed,and the rate of urinary system infections,the distribution and proportion of pathogenic bacteria and drug resistance in urinary system infections were statistically analyzed.SPSS 13.0 was adopted for statistical analysis.RESULTS Totally 33 cases appeared the urinary system infections,and the infection rate was 4.8%.There were11 cases with severe infections,and the infection rate was 1.6%.And 4cases were septic shock,and the infection rate was 0.6%.Totally 72 strains were identified,containing 51 strains of gram-negative bacteria(70.8%)and20strains of gram-positive bacteria(27.8%).The main pathogenic bacteria was Escherichia coli(30.5%).The main gram-negative bacteria were sensitive to cefuroxime,amoxicillin,amikacin and imipenem(the drug resistance rate was 0~45.5%),and highly resistance to cefazolin,ceftriaxone and ampicillin(the drug resistance rate was54.5%~100.0%).The main gram-positive bacteria were sensitive to vancomycin,teicoplanin and ofloxacin(the drug resistance rate was 0~28.6%),and highly resistant to penicillin G,gentamicin and erythromycin(the drug resistance rate was 71.4%~100.0%).CONCLUSION The infection rate of urinary system infections in patients treating with endoscopic lithotripsy was high,and the infected bacteria was mainly belonged to Escherichia coli.It′s good for clinical rational using antimicrobial drugs to strengthen monitoring of pathogenic bacteria.
OBJECTIVE To investigate the urinary system infections in patients treating with endoscopic lithotripsy so as to guide the prevention and application of antibiotics on patients with upper urinary calculi.METHODS The clinical data of 682 patients treating with endoscopic lithotripsy in hospital from Feb.2011 to Mar.2015 were analyzed,and the rate of urinary system infections,the distribution and proportion of pathogenic bacteria and drug resistance in urinary system infections were statistically analyzed.SPSS 13.0 was adopted for statistical analysis.RESULTS Totally 33 cases appeared the urinary system infections,and the infection rate was 4.8%.There were11 cases with severe infections,and the infection rate was 1.6%.And 4cases were septic shock,and the infection rate was 0.6%.Totally 72 strains were identified,containing 51 strains of gram-negative bacteria(70.8%)and20strains of gram-positive bacteria(27.8%).The main pathogenic bacteria was Escherichia coli(30.5%).The main gram-negative bacteria were sensitive to cefuroxime,amoxicillin,amikacin and imipenem(the drug resistance rate was 0~45.5%),and highly resistance to cefazolin,ceftriaxone and ampicillin(the drug resistance rate was54.5%~100.0%).The main gram-positive bacteria were sensitive to vancomycin,teicoplanin and ofloxacin(the drug resistance rate was 0~28.6%),and highly resistant to penicillin G,gentamicin and erythromycin(the drug resistance rate was 71.4%~100.0%).CONCLUSION The infection rate of urinary system infections in patients treating with endoscopic lithotripsy was high,and the infected bacteria was mainly belonged to Escherichia coli.It′s good for clinical rational using antimicrobial drugs to strengthen monitoring of pathogenic bacteria.
引文
[1]汪巧萍,蔡珺,沈海萍.手术室老年患者输尿管软镜碎石术后感染的预防措施[J].中华医院感染学杂志,2014,24(4):979-980.
[2]李辉,王伟高,谢波.输尿管镜钬激光碎石术对输尿管结石术患者发生感染的可行性及安全性研究[J].中华医院感染学杂志,2015,25(8):1857-1959.
[3]Ceban E.The treatment of the reno-ureteral calculi by extracorporeal shockwave lithotripsy[J].J Med Life,2012,5(2):133-138.
[4]陈伟,肖仁举,毕磊.输尿管碎石术后泌尿系统感染病原菌及耐药性分析[J].中国病原生物学杂志,2012,7(11):861-863.
[5]Ito H,Kawahara T,Terao H,et al.Predictive value of attenuation coefficients measured as Hounsfield units on noncontrast computed tomography during flexible ureteroscopy with holmium laser lithotripsy:a single-center experience[J].J Endourol,2012,26(9):1125-1130.
[6]Turney BW,Reynard JM,Noble JG,et al.Trends in urological stone disease[J].BJU Int,2012,109(7):1082-1087.
[7]Franiczek R,Sobieszczanska B,Turniak M,et al.ESBL-producing Escherichia coli isolated from children with acute diarrhea-antimicrobial susceptibility,adherence paterns and phylogenetic background[J].Adv Clin Exp Med,2012,21(2):187-192.
[2]李辉,王伟高,谢波.输尿管镜钬激光碎石术对输尿管结石术患者发生感染的可行性及安全性研究[J].中华医院感染学杂志,2015,25(8):1857-1959.
[3]Ceban E.The treatment of the reno-ureteral calculi by extracorporeal shockwave lithotripsy[J].J Med Life,2012,5(2):133-138.
[4]陈伟,肖仁举,毕磊.输尿管碎石术后泌尿系统感染病原菌及耐药性分析[J].中国病原生物学杂志,2012,7(11):861-863.
[5]Ito H,Kawahara T,Terao H,et al.Predictive value of attenuation coefficients measured as Hounsfield units on noncontrast computed tomography during flexible ureteroscopy with holmium laser lithotripsy:a single-center experience[J].J Endourol,2012,26(9):1125-1130.
[6]Turney BW,Reynard JM,Noble JG,et al.Trends in urological stone disease[J].BJU Int,2012,109(7):1082-1087.
[7]Franiczek R,Sobieszczanska B,Turniak M,et al.ESBL-producing Escherichia coli isolated from children with acute diarrhea-antimicrobial susceptibility,adherence paterns and phylogenetic background[J].Adv Clin Exp Med,2012,21(2):187-192.