膀胱全切术后泌尿系感染的影响因素分析

Analysis of influence factors of urinary tract infection after total cystectomy

目的探究膀胱全切术后泌尿系感染的影响因素。方法选取2014年12月～2017年12月我院收治的膀胱全切术后泌尿系感染60例患者作为感染组,并选取同期住院但未发生感染的患者60例作为对照组,进行回顾性分析。收集尿液进行尿标本培养,记录并分析患者资料,对影响膀胱全切术后泌尿系感染的危险因素进行单因素和Logistic多因素回归分析。结果收集膀胱全切术后泌尿系感染的患者标本60例,共检出病原菌60例,检出率为100.00%。其中,革兰阴性菌诱发的术后泌尿系统感染发生率(68.33%)明显高于革兰阳性菌(26.67%)及真菌(5.00%),差异有统计学意义(P<0.05)。经单因素分析显示,年龄、机体免疫功能、基础疾病、使用抗菌药物与膀胱全切术后泌尿系感染密切相关(P<0.05)。经Logistic多因素分析结果提示,年龄≥60岁、机体免疫功能低下、存在基础疾病及未使用抗菌药物是诱发膀胱全切术后泌尿系感染的危险因素(P<0.05)。结论革兰阳性菌与革兰阴性菌均可诱发膀胱全切术后泌尿系感染,其危险因素主要为年龄≥60岁、存在基础疾病、机体免疫功能低下、未使用抗菌药物等,针对相关危险因素提出预防及处理对策,可尽最大程度避免膀胱全切术后泌尿系感染的发生,提高临床医疗质量。

Objective To investigate the influencing factors of urinary tract infection(URI) after total cystectomy.Methods A total of 60 patients with URI after total cystectomy was performed in our hospital from December 2014 to December 2017, which was classified into infection group. During the same time, another group of 60 inpatients who didn′t suffer from infection was enrolled as control group, retrospective analysis was conducted. Urine samples were collected for urine culture, and patient data were recorded and analyzed. Univariate Logistic multivariate regression analysis was performed to analyze the risk factors of urinary tract infection after total cystectomy. Results Sixty specimens from URI patients after total cystectomy were collected,and pathogens were detected in 60 cases, and the detection rate was 100.00%. Among them, incidence of postoperative urinary tract infection induced by Gram-negative bacteria was68.33%, which was significantly higher than Gram-positive bacteria and fungi accounting for 26.67% and 5.00% respectively, the differences were statistically significant(P<0.05). Univariate analysis showed that age, immune function of the body, underlying disease, and antibacterial use were closely related to URI after total cystectomy(P<0.05). Logistic multivariate analysis showed that age ≥60 years old, underlying disease, low immunity, absence of using antibiotics were the risk factors for URI after total cystectomy(P<0.05). Conclusion Gram-positive bacteria and Gram-negative bacteria both can induce URI after total cystectomy. The principal risk factors are age ≥60 years old, underlying disease, low immunity, absence of using antibiotics. Targeted on these risk factors, prevention and treatment strategies should be proposed in order to avoid the occurrence of URI after total cystectomy to large extent and improve the quality of clinical care.