输尿管镜术后泌尿道感染发病率及其危险因素

Incidence and risk factors of urinary tract infection after ureteroscopy

目的探讨输尿管镜术后感染的发病率及其危险因素。方法回顾性分析2002—2011年某院接受输尿管镜检查或输尿管镜下碎石术患者,收集其年龄、性别、既往史、合并症、尿常规、尿培养、血常规、是否留置导尿管或输尿管内支架以及抗菌药物的使用等临床资料,对所得数据进行分析。结果输尿管镜术后泌尿道感染的发病率为3.77%(20/531),其中输尿管镜检查术后泌尿道感染的发病率为5.84%(9/154),高于输尿管镜碎石术后的2.92%(11/377)(χ2=5.47,P=0.02)。术后感染患者以肾盂肾炎最常见(15例),分离主要病原菌为大肠埃希菌(6株)。预防性使用不同种类抗菌药物者泌尿道感染发病率差异无统计学意义(P=0.185)。菌尿症、肾积水、留置导尿管、术后无内支架管置入、未预防性使用抗菌药物患者泌尿道感染发病率较高(均P<0.05)。结论菌尿症、肾积水、留置导尿管、术后无内支架管置入、输尿管镜检查术、未预防性使用抗菌药物是输尿管镜术后泌尿道感染的危险因素。

Objective To evaluate the incidence and risk factors of urinary tract infection（UTI）following ureteroscopy.Methods Patients undergoing ureteroscopy examination or ureteroscopic lithotripsy in a hospital between2002 and 2011 were analyzed retrospectively,clinical data of patients were collected and analyzed,including age,sex,history,complication,urine routine test,urine culture,blood routine test,urethral catheterization,ureteral stent placing and antimicrobial use.Results Incidence of UTI following ureteroscopy was 3.77%（20/531）,UTI following ureteroscopy examination was higher than ureteroscopic lithotripsy（5.84%[9/154]vs 2.92%[11/377]）.Pyelonephritis was the main infection type（n=15）,the main pathogen was Escherichia coli（n=6）,there was no statistical difference in UTI among patients receiving different types of antimicrobial prophylaxis（P=0.185）.Patients with bacteriuria,hydronephrosis,urethral catheterization,without ureteral stent placing,and without receiving antimicrobial prophylaxis had higher incidence of URI（all P〈0.05）.Conclusion Bacteriuria,hydronephrosis,urethral catheterization,without postoperative ureteral stent placing,ureteroscopy examination,and without receiving antimicrobial prophylaxis are risk factors of UTI following ureteroscopy.