膀胱肿瘤患者灌注化疗后并发尿路感染的影响因素研究
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摘要
目的研究分析膀胱肿瘤患者灌注化疗后并发尿路感染的影响因素及相关预防干预措施。方法选择医院2015年4月-2017年4月收治的膀胱肿瘤接受灌注化疗的患者1 613例作为研究对象,观察膀胱肿瘤患者灌注化疗后并发尿路感染情况,并分析其相关因素,提出对应性预防干预措施。结果 1 613例膀胱肿瘤患者灌注化疗后并发尿路感染共382例,占23.68%。尿液培养共发现病原菌424株,以革兰阴性菌为主,占69.10%,其中以大肠埃希菌和鲍氏不动杆菌为主,分别占25.47%、19.10%,二者对左氧氟沙星及美罗培南具有较强的药物敏感性,对头孢噻肟、头孢西丁、头孢吡肟具有较强的耐药性。年龄≥65岁、白蛋白水平<35 g/L、灌注化疗次数≥5次、留置导尿管、多个肿瘤位点、合并糖尿病均是膀胱肿瘤患者灌注化疗后并发尿路感染的独立影响因素(P<0.05)。结论膀胱肿瘤患者灌注化疗后并发尿路感染比例较高,且受多种因素影响。临床上治疗膀胱肿瘤并行灌注化疗的患者的同时,需提高预防感染的认识程度,针对存在的影响因素,给予相应预防干预措施,降低尿路感染发生率。
OBJECTIVE To expore the influenicng factors for complicated urinary tract infection in bladder tumor patients after perfusion chemotherapy and put forward targeted prevention interventions. METHODS A total of 1 613 bladder tumor patients who received perfusion chemotherapy in the hospital from Apr 2015 to Apr 2017 were recruited as the study objects, the incidence of complicated urinary tract infection was investigated after the perfusion chemotherapy, the related factors for the infection were analyzed, and the targeted prevention interventions were put forward. RESULTS Of the 1 613 bladder tumor patients, 382(23.68%) had urinary tract infection after the perfusion chemotherapy. Totally 424 strains of pathogens were isolated from urine specimens, 69.10% of which were gram-negative bacteria; Escherichia coli and Acinetobacter baumannii were the predominant species of the gram-negative bacteria, accounting for 25.47% and 19.10%, respectively, and the two species were highly susceptible to levofloxacin and meropenem but were hihgly resistant to cefotaxime, cefoxitin and cefepime. The no less than 65 years of age, albumin level less than 35 g/L, no less than 5 times of perfusion chemotherapy, urinary catheter indwelling, multiple tumor sites and complication with diabetes mellitus were the independent influencing factors for the complicated urinary tract infection in the bladder tumor patients after the perfusion chemotherapy(P<0.05). CONCLUSION The incidence of complicated urinary tract infection is high among the bladder tumor patients after the perfusion chemotherapy and is affected by a variety of factors. It is necessary for the hospital to pay great attention to the prevention of urinary tract infection in the bladder tumor patients undergoing perfusion chemotherapy and take targeted prevention interventions according to the influencing factors so as to reduce the incidence of urinary tract infection.
OBJECTIVE To expore the influenicng factors for complicated urinary tract infection in bladder tumor patients after perfusion chemotherapy and put forward targeted prevention interventions. METHODS A total of 1 613 bladder tumor patients who received perfusion chemotherapy in the hospital from Apr 2015 to Apr 2017 were recruited as the study objects, the incidence of complicated urinary tract infection was investigated after the perfusion chemotherapy, the related factors for the infection were analyzed, and the targeted prevention interventions were put forward. RESULTS Of the 1 613 bladder tumor patients, 382(23.68%) had urinary tract infection after the perfusion chemotherapy. Totally 424 strains of pathogens were isolated from urine specimens, 69.10% of which were gram-negative bacteria; Escherichia coli and Acinetobacter baumannii were the predominant species of the gram-negative bacteria, accounting for 25.47% and 19.10%, respectively, and the two species were highly susceptible to levofloxacin and meropenem but were hihgly resistant to cefotaxime, cefoxitin and cefepime. The no less than 65 years of age, albumin level less than 35 g/L, no less than 5 times of perfusion chemotherapy, urinary catheter indwelling, multiple tumor sites and complication with diabetes mellitus were the independent influencing factors for the complicated urinary tract infection in the bladder tumor patients after the perfusion chemotherapy(P<0.05). CONCLUSION The incidence of complicated urinary tract infection is high among the bladder tumor patients after the perfusion chemotherapy and is affected by a variety of factors. It is necessary for the hospital to pay great attention to the prevention of urinary tract infection in the bladder tumor patients undergoing perfusion chemotherapy and take targeted prevention interventions according to the influencing factors so as to reduce the incidence of urinary tract infection.
引文
[1] 张爱英,朱海鹏,葛恩红,等.膀胱肿瘤灌注化疗患者尿路感染相关因素分析[J].中华医院感染学杂志,2016,26(12):2817-2818.
[2] Yang J,Zhang P,Zhou H,et al.Prospective,randomized controlled study of the preventive effect of fosfomycin tromethamineon post-transurethral resection of bladder tumor urinary tract infection[J].Int J Urol,2018,25(10):894-895.
[3] 刘桂玲,朱小芳,牛梦铱,等.经尿道膀胱肿瘤切除患者术后尿路感染的高危因素及病原菌分布研究[J].中华医院感染学杂志,2017,27(11):2547-2550.
[4] Friedlander E,Martinez Pascual P,Montilla de Mora P,et al.Bilateral parotid glands infection caused by Calmette-Guerin Bacillus after intravesical therapyfor recurrent bladder cancer:a case report[J].Braz J Otorhinolaryngol,2017,83(6):726-729.
[5] 姬俊鹏,程文超,王文军.膀胱肿瘤切除术后尿路感染病原菌分布及相关因素分析[J].实用癌症杂志,2017,8(9):1547-1549.
[6] 王建平,赵宪龙,常斌.泌尿外科患者尿路感染危险因素分析与临床预防研究[J].医药前沿,2015,3(36):129-130.
[7] Zheng C,Han X,Feng S,et al.Value of urine sediment analyzer in the screening of urinary tract infection in cancer patients[J].Zhonghua Zhong Liu Za Zhi,2016,38(1):35-39.
[8] 岳敏,谢庆环,许红梅.腹腔镜下根治性膀胱癌术后早期尿路感染相关因素分析[J].中国卫生标准管理,2017,2(5):36-39.
[9] Bayne CE,Farah D,Herbst KW,et al.Role of urinary tract infection in bladder cancer:a systematic review and meta-analysis[J].World J Urol,2018,36(8):1181-1190.
[10] 刘玉庆,李璐璐,骆延波,等.EUCAST欧盟药敏试验标准[M].中国质量与标准导报,2011(5):60.
[11] Chaaya G,Morales J,Castiglioni A,et al.Paraganglioma of the urinary bladder:a rare cause of hypertension and urinary tract infections[J].Am J Med Sci,2018,355(2):191-194.
[12] Higashioka K,Miyake N,Nishida R,et al.Bilateral granulomatous renal masses after intravesical BCG therapy for non-muscle-invasive bladder cancer and carcinoma in situ of the upper urinary tract:a case study[J].Kansenshogaku Zasshi,2015,89(4):481-484.
[13] Stone L.Bladder cancer:urinary tract infection increases risk[J].Nat Rev Urol,2015,12(1):4.
[14] 陈晨,杨建伟,李向利,等.膀胱镜检查后患者发生尿路感染的临床分析[J].医药前沿,2017,7(33):130-131.
[15] Kim BS,Tae BS,Ku JH,et al.Rate and association of lower urinary tract infection with recurrence after transurethral resectionof bladder tumor[J].Investig Clin Urol,2018,59(1):10-17.
[16] 李正斌.老年人尿路感染的临床特点及诊治要点分析[J].临床医学研究与实践,2017,8(34):91-92.
[17] Kim KH,Yoon HS,Yoon H,et al.Febrile urinary tract infection after radical cystectomy and ileal neobladder in patients with bladder cancer[J].J Korean Med Sci,2016,31(7):1100-1104.
[18] Richards KA,Ham S,Cohn JA,et al.Urinary tract infection-like symptom is associated with worse bladder cancer outcomes in the medicare population:implications for sex disparities[J].Int J Urol,2016,23(1):42-47.
[19] 李朋,张伟丽,尤升杰,等.泌尿外科患者尿路感染危险因素分析与临床预防研究[J].中华医院感染学杂志,2015,25(7):1626-1628.
[20] Ball MW.Editorial Comment to Urinary tract infection-like symptom is associated with worse bladdercancer outcomes in the medicare population:implications for sex disparities[J].Int J Urol,2016,23(1):48.
[21] 陈尧康,虞利民,黄正,等.膀胱肿瘤术后膀胱灌注化疗患者尿路感染的危险因素分析[J].中华医院感染学杂志,2014,24(24):6182-6184.
[22] Vermeulen SH,Hanum N,Grotenhuis AJ,et al.Recurrent urinary tract infection and risk of bladder cancer in the Nijmegen bladder cancerstudy[J].Br J Cancer,2015,112(3):594-600.
[23] Hartman C,Williamson AK,Friedman AA,et al.Bladder ganglioneuroma in a 5-year-old girl presenting with a urinary tract infection and hematuria:case report and review of the literature[J].Urology,2015,85(2):467-469.
[2] Yang J,Zhang P,Zhou H,et al.Prospective,randomized controlled study of the preventive effect of fosfomycin tromethamineon post-transurethral resection of bladder tumor urinary tract infection[J].Int J Urol,2018,25(10):894-895.
[3] 刘桂玲,朱小芳,牛梦铱,等.经尿道膀胱肿瘤切除患者术后尿路感染的高危因素及病原菌分布研究[J].中华医院感染学杂志,2017,27(11):2547-2550.
[4] Friedlander E,Martinez Pascual P,Montilla de Mora P,et al.Bilateral parotid glands infection caused by Calmette-Guerin Bacillus after intravesical therapyfor recurrent bladder cancer:a case report[J].Braz J Otorhinolaryngol,2017,83(6):726-729.
[5] 姬俊鹏,程文超,王文军.膀胱肿瘤切除术后尿路感染病原菌分布及相关因素分析[J].实用癌症杂志,2017,8(9):1547-1549.
[6] 王建平,赵宪龙,常斌.泌尿外科患者尿路感染危险因素分析与临床预防研究[J].医药前沿,2015,3(36):129-130.
[7] Zheng C,Han X,Feng S,et al.Value of urine sediment analyzer in the screening of urinary tract infection in cancer patients[J].Zhonghua Zhong Liu Za Zhi,2016,38(1):35-39.
[8] 岳敏,谢庆环,许红梅.腹腔镜下根治性膀胱癌术后早期尿路感染相关因素分析[J].中国卫生标准管理,2017,2(5):36-39.
[9] Bayne CE,Farah D,Herbst KW,et al.Role of urinary tract infection in bladder cancer:a systematic review and meta-analysis[J].World J Urol,2018,36(8):1181-1190.
[10] 刘玉庆,李璐璐,骆延波,等.EUCAST欧盟药敏试验标准[M].中国质量与标准导报,2011(5):60.
[11] Chaaya G,Morales J,Castiglioni A,et al.Paraganglioma of the urinary bladder:a rare cause of hypertension and urinary tract infections[J].Am J Med Sci,2018,355(2):191-194.
[12] Higashioka K,Miyake N,Nishida R,et al.Bilateral granulomatous renal masses after intravesical BCG therapy for non-muscle-invasive bladder cancer and carcinoma in situ of the upper urinary tract:a case study[J].Kansenshogaku Zasshi,2015,89(4):481-484.
[13] Stone L.Bladder cancer:urinary tract infection increases risk[J].Nat Rev Urol,2015,12(1):4.
[14] 陈晨,杨建伟,李向利,等.膀胱镜检查后患者发生尿路感染的临床分析[J].医药前沿,2017,7(33):130-131.
[15] Kim BS,Tae BS,Ku JH,et al.Rate and association of lower urinary tract infection with recurrence after transurethral resectionof bladder tumor[J].Investig Clin Urol,2018,59(1):10-17.
[16] 李正斌.老年人尿路感染的临床特点及诊治要点分析[J].临床医学研究与实践,2017,8(34):91-92.
[17] Kim KH,Yoon HS,Yoon H,et al.Febrile urinary tract infection after radical cystectomy and ileal neobladder in patients with bladder cancer[J].J Korean Med Sci,2016,31(7):1100-1104.
[18] Richards KA,Ham S,Cohn JA,et al.Urinary tract infection-like symptom is associated with worse bladder cancer outcomes in the medicare population:implications for sex disparities[J].Int J Urol,2016,23(1):42-47.
[19] 李朋,张伟丽,尤升杰,等.泌尿外科患者尿路感染危险因素分析与临床预防研究[J].中华医院感染学杂志,2015,25(7):1626-1628.
[20] Ball MW.Editorial Comment to Urinary tract infection-like symptom is associated with worse bladdercancer outcomes in the medicare population:implications for sex disparities[J].Int J Urol,2016,23(1):48.
[21] 陈尧康,虞利民,黄正,等.膀胱肿瘤术后膀胱灌注化疗患者尿路感染的危险因素分析[J].中华医院感染学杂志,2014,24(24):6182-6184.
[22] Vermeulen SH,Hanum N,Grotenhuis AJ,et al.Recurrent urinary tract infection and risk of bladder cancer in the Nijmegen bladder cancerstudy[J].Br J Cancer,2015,112(3):594-600.
[23] Hartman C,Williamson AK,Friedman AA,et al.Bladder ganglioneuroma in a 5-year-old girl presenting with a urinary tract infection and hematuria:case report and review of the literature[J].Urology,2015,85(2):467-469.