输尿管上段结石微创治疗术后医院感染的临床分析

Clinical analysis of postoperative nosocomial infections in upper ureteral calculi patients undergoing minimally invasive surgery

目的分析微创手术治疗复杂性输尿管上段结石术后医院感染的临床特点,为术后医院感染的预防控制提供参考依据。方法回顾性分析2010年3月-2014年3月916例接受微创手术治疗的复杂性输尿管上段结石患者临床资料,统计微创手术治疗患者术后医院感染率,并分析感染患者的病原菌分布及耐药性;采用SPSS13.0软件进行统计分析。结果 916例患者共发生医院感染82例,感染率8.95%,均为泌尿系感染;82例感染患者共分离出病原菌262株,其中革兰阴性菌199株占75.95%,革兰阳性菌59株占22.52%,真菌7株占2.67%,其他病原菌4株占1.53%;主要革兰阴性菌对亚胺培南、哌拉西林耐药性较低,均<10.00%,对氨苄西林、头孢唑林、环丙沙星耐药性较高,均>50.00%;主要革兰阳性菌对万古霉素、氨苄西林、利奈唑胺耐药性较低,均为0,对庆大霉素、红霉素、头孢拉定及磺胺甲噁唑/甲氧苄啶耐药性较高,均>85.00%。结论微创手术治疗复杂性输尿管上段结石术后医院感染率仍较高,其病原菌构成与普通尿路感染无明显差异,随着抗菌药物的滥用,耐药菌株不断增加,在临床治疗中应按照病原菌分布及患者的药物使用史合理应用抗菌药物,做到有效预防控制术后医院感染,保证患者的预后。

OBJECTIVE To investigate the clinical characteristics of the postoperative nosocomial infections in the complicated upper ureteral calculi patients undergoing minimally invasive surgery so as to provide guidance for control of the postoperative nosocomial infections.METHODS The clinical data of 916 patients with complicated upper ureteral calculi who underwent the minimally invasive surgery from Mar 2010 to Mar 2014 were retrospectively analyzed,the incidence of the postoperative nosocomial infections was observed,the distribution and drug resistance of the pathogens causing the infections were analyzed,and the statistical analysis was performed with the use of SPSS13.0software.RESULTS Of the 916 patients,82had the nosocomial infections with the infection rate of8.95%,all of whom had urinary system infections.A total of 262 strains of pathogens were isolated from the 82 patients with infections,including 199（75.95%）strains of gram-negative bacteria,59（22.52%）strains of grampositive bacteria,7（2.67%）strains of fungi,and 4（1.43%）strains of other species.The drug resistance rates of the main gram-negative bacteria to imipenem and piperacillin were less than 10.00%;the drug resistance rates to ampicillin,cefazolin,and ciprofloxacin were more than 50.00%.The drug resistance rates of the main gram-positive bacteria to vancomycin,ampicillin,and linezolid were 0,while the drug resistance rates to gentamicin,erythromycin,cefradine,and sulfamethoxazole-trimethoprim were more than 85.00%.CONCLUSION The incidence of the postoperative nosocomial infections remains high in the complicated upper ureteral calculi patients undergoing the minimally invasive surgery.The constituent ratios of the pathogens do not differ significantly with the common urinary tract infections.With the abuse of antibiotics and the continuous increase of the drug-resistant strains,it is necessary to reasonably use antibiotics during the clinical treatment according to the distribution of the pathogens and history of use of drugs so as to effectively control the postoperative nosocomial infections and ensure the prognosis of the patients.