摘要
目的分析上海松江地区肾结石患者结石培养和术前尿培养结果的临床特点以及与其术后感染的关系。方法回顾性分析上海交通大学医学院附属松江医院2020年1月—2022年6月收住入院的213例肾结石患者资料,所有患者行术前清洁中段尿培养、药敏实验及结石培养,并分析不同性别患者的细菌差异,结石/细菌培养阳性者与阴性者术后发生感染的差异性。结果213例肾结石患者中,尿培养阳性者47例(22.1%),其中大肠埃希菌最为常见[20株(42.6%)]。女性患者中大肠埃希菌比例显著高于男性患者[12株(48.0%)vs.8株(36.4%),P<0.05],而男性患者中肺炎克雷伯杆菌比例显著高于女性[5株(22.7%)vs.3株(12.0%),P<0.05],药敏结果显示:主要的革兰阴性菌对氨卞西林/舒巴坦、头孢唑啉、头孢呋辛等耐药性较高,而对亚胺培南、卡那霉素、哌拉西林/他唑巴坦等敏感性较高;主要的革兰阳性菌对克林霉素、红霉素、左氧氟沙星耐药性较高,而对万古霉素、替考拉宁、利奈唑胺敏感性较高。结石培养阳性者31例(14.6%),最常见的细菌分别为:奇异变形菌9株(29.0%)。而男性与女性患者在主要细菌谱上未见明显差异。术后发生发热/尿源性脓毒血症者中尿培养/结石培养阳性者比例明显高于阴性者(P<0.05)。结论上海松江地区肾结石患者尿液菌谱以大肠杆菌为主,并且与结石培养结果差异性较大,临床上应加强结石培养等病原学检测,合理使用抗生素,降低术后感染的发生。
Objective To analyze the clinical characteristics of stone culture and preoperative urine culture of patients with renal calculi in Songjiang area of Shanghai and the relationship with postoperative infection.Methods The clinical data of 213 patients with kidney stones treated at our hospital during Jan.2020 and Jun.2022 were retrospectively analyzed.All patients underwent preoperative clean midcourse urine culture,drug sensitivity test and stone culture.The gender difference between male and female patients and the difference in postoperative infection between stone/bacterial culture positive and negative patients were analyzed.Results Among the 213 patients,47(22.1%)had positive urine culture,and the most common bacterium was Escherichia coli(20 strains,42.6%).The proportion of Escherichia coli was significantly higher in female patients than in male patients[12 strains(48.0%)vs.8 strains(36.4%),P<0.05],while the proportion of Klebsiella pneumoniae was significantly higher in male patients than in female patients[5 strains(22.7%)vs.3 strains(12.0%),P<0.05].Drug sensitivity results showed the main Gram-negative bacteria were highly resistant to ampicillin/sulbactam,cefazolin and cefuroxime,but sensitive to imipenem,kanamycin and piperacillin/tazobactam.The main Gram-positive bacteria were highly resistant to clindamycin,erythromycin and levofloxacin,but sensitive to vancomycin,teicoplanin and linezolid.Stone culture was positive in 31 cases(14.6%),and the most common bacterium was Proteus mirabilis(9 strains,29.0%).However,there was no significant difference in the main bacterial spectrum between male and female patients.The positive rate of urine culture/stone culture in patients with postoperative fever/urosepsis was significantly higher than that in patients with negative urine culture/stone culture(P<0.05).Conclusion Escherichia coli is the main urinary spectrum of patients with kidney stones in Songjiang area,which is greatly different from the stone culture results.In clinical practice,etiological detection and antibiotics are necessary to reduce the occurrence of postoperative infection.
作者
方道成
陈立新
唐春华
王勇
胡媛媛
徐蕾蕾
FANG Daocheng;CHEN Lixin;TANG Chunhua;WANG Yong;HU Yuanyuan;XU Leilei(Department of Urology,Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 201600,China;Department of General Medicine,Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 201600,China)
出处
《现代泌尿外科杂志》
CAS
2023年第4期342-346,共5页
Journal of Modern Urology
关键词
肾结石
尿培养
结石培养
感染
药敏试验
上海松江地区
kidney stones
urine culture
stone culture
infection
drug sensitive test
Songjiang area of Shanghai
