摘要
目的调查软性输尿管镜下激光碎石术后感染危险因素,同时评估术前尿培养物中病原体的分布和耐药率。方法回顾性收集2013年6月-2017年6月于本院接受软性输尿管镜激光碎石术的500例肾结石患者,术前对所有患者进行尿培养,尿培养阳性的患者进一步鉴定病原菌的多重耐药性。根据是否发生术后感染并发症将患者分为感染组45例和非感染组455例。比较两组患者的临床资料,对相关指标进行Logistic回归分析,分析感染危险因素。结果 500例结肾结石患者软性输尿管镜下激光碎石术后,45例发生术后感染并发症,发生率为9.0%。感染组与未感染组的性别、年龄、BMI、结石位置、结石手术史均无统计学差异(P>0.05),但两组在糖尿病史、结石大小、术前尿培养结果、手术时间和住院时间方面具有统计学差异(P<0.05)。尿培养阳性患者共69例,感染病原菌中革兰氏阴性菌多于革兰氏阳性菌。根据病原菌多重耐药分析结果,将术前尿培养阳性患者分为多重耐药组和非多重耐药组,两组病原菌分布无统计学差异(P>0.05),但多重耐药组的耐药率显著更高(P<0.001)。多因素Logistic回归分析发现,术前尿培养阳性-多重耐药菌感染是软性输尿管镜下激光碎石术后感染的独立危险因素(P=0.005)。结论术前尿培养阳性-多重耐药病原菌感染是软性输尿管镜下激光碎石术后感染并发症的重要危险因素。术前尿培养阳性患者感染的病原菌中,革兰氏阴性菌多于革兰氏阳性菌。
Objective To investigate the risk factors for infections after flexible uretero-renoscopy with laser lithotripsy and to evaluate the distribution and drug resistance rate of pathogens in preoperative urine cultures.Methods A total of 500 cases of nephrolithiasis who had undergone soft ureteroscopic laser lithotripsy were retrospectively collected at Hospital 252 between June 2013 and June 2017.All the patients were given urine cultures and urine culture positive patients had their multi-drug resistance of pathogens identified before operation.According to postoperative complications,patients were divided into the infection group(45 cases)and non-infection group(455 cases).The clinical data of the two groups was compared.Logistic regression analysis was used to analyze related risk factors.Results A total of 45 cases suffered from postoperative infectious complications,and the incidence of infectious complications was 9%.There was no significant difference in gender,age,BMI,location of stones and previous history of surgery of stones between the two groups(P>0.05),but there was significant difference in history of diabetes mellitus,stone size,preoperative urinary cultures,duration of surgey and length of hospital stay(P<0.05).There were a total of 69 cases of positive urinary cultures.Gram-negative bacteria outnumbered gram-positive bacteria in the infected pathogens.According to the results of multiple drug resistance analysis of pathogenic bacteria,preoperative urinary culture positive patients were divided into the multi-drug resistant group and non-multi-drug resistant group,and there was no significant difference in the distribution of pathogenic bacteria between the two groups(P>0.05).However,the drug resistance rates were significantly higher in the multi-drug resistant group(P<0.001).Multivariate logistic regression analysis showed that a preoperative urinary culture with multi-drug resistant bacteria was an independent risk factor for infectious complications after flexible uretero-renoscopy with laser lithotripsy(P=0.005).Conclusion Preoperative urinary cultures with multi-drug resistant bacteria are an independent risk factor for infectious complications after flexible uretero-renoscopy with laser lithotripsy.Gramnegative bacteria outnumber gram-positive bacteria in infected pathogens.
作者
殷晓松
刘文燕
史建国
韩刚
王领军
李春吾
YIN Xiaosong;LIU Wenyan;SHI Jianguo;HAN Gang;WANG Lingjun;LI Chunwu(Department of Urinary Surgery,Hospital 252 of PLA,Baoding Hebei 073000,China)
出处
《解放军预防医学杂志》
CAS
2018年第2期204-207,共4页
Journal of Preventive Medicine of Chinese People's Liberation Army
基金
保定市科学研究与发展计划项目(No.17ZF288)
关键词
肾结石
输尿管镜下激光碎石术
术后感染
危险因素
病原菌
kidney stone,flexible uretero-renoscopy with laser lithotripsy
postoperative infection
risk factor
pathogen
