前列腺增生症术后尿路感染病原菌分布及细胞炎性机制研究

Study on the distribution characteristics of pathogens and cellular inflammatory mechanism of urinary tract infection after prostatic hyperplasia

目的探讨前列腺增生症术后尿路感染病原菌分布特点及细胞炎性机制研究。方法选择医院2012年1月-2017年12月收治的行经尿道等离子前列腺切除术(TURP)前列腺增生症患者205例。分析患者术后尿路感染发生率,感染病原菌分布情况及耐药性,观察感染与未感染患者细胞炎性因子变化。结果行TURP术前列腺增生症患者205例,术后发生尿路感染39例,感染率为19.02%;术后尿路感染39例患者共分离病原菌47株,其中包括革兰阴性菌29株、革兰阳性菌15株、真菌3株;主要革兰阴性菌中,大肠埃希菌对头孢唑林和氨苄西林耐药性较高,肺炎克雷伯菌对氨苄西林和头孢他啶耐药性较高;主要革兰阳性菌中,屎肠球菌对红霉素和青霉素G耐药性较高;感染患者血清单核细胞趋化蛋白1(MCP1)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、成纤维细胞生长因子2(FGF2)和成纤维细胞生长因子7(FGF7)水平高于未感染患者(P<0.05)。结论前列腺增生症术后尿路感染病原菌以革兰阴性菌为主,病原菌耐药现象日趋严重,应提高基础疾病治疗,应根据药敏试验合理选择抗菌药物,且术后尿路感染患者存在明显细胞炎性反应。

OBJECTIVE To investigate the distribution characteristics of pathogens and the mechanism of inflammatory cells in urinary tract infection after prostatic hyperplasia. METHODSTotally 205 patients with benign prostatic hyperplasia treated by plasma prostatectomy (TURP) during the period of Jan. 2012-Dec.2017 were selected. The incidence of postoperative urinary tract infection, the distribution and drug resistance of pathogens in the patients were analyzed, and the changes of inflammatory factors in the infected and uninfected groups were observed. RESULTS Among the 205 patients with prostatic hyperplasia treated with TURP, 39 cases of urinary tract infection occurred after operation, and the infection rate was 19.02%. 47 strains of pathogens were isolated from the 39 patients with postoperative urinary tract infection, including 29 strains of Gram-negative bacteria, 15 strains of Gram-positive bacteria and 3 strains of fungi. Among the main Gram-negative bacteria, the resistance rates of Escherichia coli to cefazolin and ampicillin were relatively high, and the resistance rates of Klebsiella pneumoniae to ampicillin and ceftazidime were relatively high. Among the main Gram-positive bacteria, the resistance rates of Enterococcus faecium to erythromycin and penicillin G were relatively high. The levels of serum monocyte chemoattractant protein 1 (MCP1), interluekin-6 (IL-6), tumor necrosis factor-a(TNF-α), fibroblast growth factor 2 (FGF2) and FGF7 were higher in the infected group than in the uninfected group (P<0.05). CONCLUSION Gram-negative bacteria are the main pathogens of urinary tract infection after prostatic hyperplasia. The drug resistance of pathogens is becoming more and more serious. We should improve the treatment of underlying diseases, and rationally choose antibiotics based on the drug sensitivity test. Moreover, patients with postoperative urinary tract infection have obvious cellular inflammatory response.