不同输尿管支架对尿路感染患者的影响及病原学分析

Influence investigation of different ureteral stents for urinary tract infections and etiological characteristics

目的探讨不同输尿管支架对患者尿路感染率的影响,并分析尿路感染病原学特点,为临床诊治提供参考。方法选择2011年5月-2014年8月286例术后输尿管实施留置支架导管的患者,按照输尿管类型分为进口聚亚胺酯复合材料双J管(进口双J组)102例、国产高分子双J管(国产双J组)98例、普通直导管(普通组)86例,对比3组患者术后尿路感染率、病原菌分布及耐药率,采用SPSS 21.0软件进行统计分析。结果 286例术后输尿管实施留置支架导管的患者发生感染106例,术后1周普通组患者感染率44.19%,明显高于进口双J组的26.47%与国产双J组的41.84%,对比差异有统计学意义(P<0.05);共分离出128株病原菌,以革兰阴性菌为主,共98株占76.56%;革兰阴性菌对妥布霉素、阿莫西林、庆大霉素等耐药率较高,可达100.00%,对亚胺培南耐药率很低;革兰阳性菌对万古霉素、利福平耐药率较低,其中对万古霉素无耐药菌检出。结论尿路感染率最低为进口聚亚胺酯复合材料双J管,临床根据病情及留置时间选择最佳输尿管支架,大肠埃希菌、金黄色葡萄球菌是主要病原菌类型,临床需根据病原学特点针对性用药。

OBJECTIVE To investigate influence of different ureteral stents for urinary tract infections and its etiological characteristics,so as to provide a reference for clinical treatment.METHODS From May 2011 to Aug.2014,a total of 286 cases of patients with postoperative indwelling ureteral stents were selected and divided according to the types of importation into double J ureteral group with 102 cases,domestic double J group with 98 cases,and the general group with 86 patients.The urinary tract infection rate,pathogen distribution and resistance rates were analyzed by SPSS 21.0software.RESULTS A total of 106 cases in the all 286 patients were infected after the operation.After 1week,the infection rate was 44.19% of ordinary group,significantly higher than that of imported group of 26.47% and domestic double J group with the rate of 41.84%（P〈0.05）.Totally 128 strains of pathogens were isolated from 106 cases.Gram-negative bacteria dominated the majority with 98 strains,accounting for 76.56%.They were highly resistant to tobramycin,amoxicilin,and gentamicin with the drug resistance rate of 100%,but they had low drug resistant rate to imipenem.Gram-positive bacteria had low drug resistant rate to vancomycin and rifampicin.No drug resistant bacteria were found in it.CONCLUSIONPolyurethane composite double J tube has least influence for urinary tract infections compared to China made polymer double J tube and ordinary straight catheter.Clinical choice should be according to the condition and indwelling ureteral stents time.Escherichia coli and Staphylococcus aureus are the major pathogenic type.Etiologic characteristics should be considered when choosing clinical drugs.