肾移植术后泌尿系感染的特点分析

Characteristics analysis of urinary tract infection in renal transplant recipients

目的探讨肾移植术后泌尿系感染的特点。方法回顾性分析2009年1月至12月在暨南大学附属第一医院进行肾移植的38例患者(男性24例,女性14例)的临床资料,对其术后1年内尿常规、尿培养结果及其他临床资料进行总结分析。结果 38例患者肾移植术后1年内共查尿常规次数787例次,其中尿常规阴性结果为633例次,标本污染53例次,细菌尿次数101例次,其中71例次发生肾移植术后半年内。101例次泌尿系感染中,无症状性菌尿为68例次,上尿路感染19例次,下尿路感染14例次,并发脓毒血症者3例次。38例患者中,共有25例(男14例、女11例)患者出现细菌尿,有19例患者出现不少于2次泌尿系感染。最常见的致病菌为大肠埃希菌(36例次),其次是粪肠球菌(26例次)。肾移植术前血液透析患者术后感染率为70%。36例术后7d内拔出尿管和双J管的患者肾移植术后感染率64%,而2例肾移植术后7d后拔出尿管和双J管患者均发生感染。术后出现膀胱输尿管反流的3例患者均出现泌尿系感染。结论肾移植术后泌尿系感染具有高发性、反复发作的特点,最常见的致病菌为大肠埃希菌。女性、尿管和双J管的长时间留置、术后膀胱输尿管反流、术前长时间血液透析等都会诱发肾移植术后的泌尿系感染。

Objective To investigate the characteristics of urinary tract infection after renal transplantation. Methods A retrospective analysis was performed on 38 patiednts （24 male and 14 female ） with renal transplantation, who were selected from the First Affiliated Hospital of Jinan University between Junuary to November 2009. The results of urine routine and urinary bacterial culture in one year after renal transplantation of 38 patients and their clinical data were summarized and analyzed. Results Totally 787 urine routine examinations were detected in post-operative 1 year in 38 patients. The results of 633 cases were negative in bacteria urine, 53 cases were contaminated, and 101 cases were positive. 71 cases developed bacteria urine within half a year after renal transplantation. For 101 cases of urinary tract infection, 68 cases were asymptomatic bacteria urine, 19 were upper urinary tract infection and 14 were lower urinary tract infection, and 3 combined with septicopyemia. Twenty-five in 38 patients （14 male and 11 female） developed bacteria urine, in which 19 patients developed urinary tract infection more than twice. The most common pathogenic bacterium was Escherichia coli （ n = 36 ） and then Enterococcus faecalis （ n = 26 ）. The postoperative infection rate was 70% in patients who underwent blood dialysis before renal transplantation. And that was 64% in 36 patients who were pulled out urinary catheter and double J tube within 7 d after renal transplantation. Two patients delayed in catheter pulling out and 3 patients complicated with vesicoureteral reflux developed urinary tract infection after transplantation. Conclusions The morbidity of urinary tract infection after renal transplantation is high, and it recurs often. The most common pathogenic bacterium is Escherichia coli.Female, long time setting of urinal）7 catheter and double J tube, postoperative vesicoureteral reflux, and preoperative blood dialysis are risk factors for urinary tract infeetion after renal transplantation.