泌尿外科患者输尿管支架置入术后发生尿路感染的危险因素及病原菌分析

Risk factors and pathogen distribution of urinary tract infection after ureteral stenting in urological patients

目的探讨泌尿外科患者输尿管支架置入术后发生尿路感染的危险因素及病原菌情况。方法收集2017年1月至2018年12月天津医科大学第二医院泌尿外科首次进行输尿管支架置入术252例患者的临床资料。以输尿管置入术后2周内发生尿路感染的84例患者为感染组,按照性别、年龄(±3岁范围内)及置管手术时间(±30 d内),1∶2匹配的原则随机选取未发生尿路感染的168例患者为对照组。采用Cox多因素回归分析泌尿外科患者首次输尿管支架置入术后发生尿路感染的危险因素,并对感染患者的病原菌分布及耐药情况进行分析。结果单因素分析显示,激素的使用、结石多发、结石直径≥2 cm、既往结石史、置管后有残留结石、置管前1个月发生尿路感染、外周血白细胞升高、中性粒细胞比例升高以及血清白蛋白降低是泌尿外科患者输尿管支架置入术后发生尿路感染的危险因素(P值均<0.05)。Cox多因素分析显示,既往结石史(OR=5.689,95%CI 1.944~16.652,P<0.01)、置管后有残留结石(OR=7.660,95%CI 3.371~17.409,P<0.01)和中性粒细胞比例升高(OR=5.586,95%CI 2.410~12.949,P<0.01)是泌尿外科患者输尿管支架置入术后发生尿路感染的独立危险因素。感染组的84例患者均为单一感染,共分离病原菌84株,其中大肠埃希菌占比最高,为28.57%(24/84)。大肠埃希菌对复方磺胺甲噁唑、左氧氟沙星、氨苄西林及头孢曲松的耐药率较高,均>60.00%,对厄他培南、亚胺培南和替加环素的敏感率均为100.00%,对其他抗菌药物的耐药率均<30.00%。结论减少结石的产生与复发及术后结石的残留,以及降低患者中性粒细胞比例均可降低输尿管支架置入术后发生尿路感染的风险。大肠埃希菌是泌尿外科患者输尿管支架置入术后发生尿路感染的主要致病菌,需引起重视。

Objective To investigate the risk factors and pathogen distribution of urinary tract infection after ureteral stenting in urological patients.Methods Eighty-four patients,who underwent ureteral stenting in Department of Urology of the Second Hospital of Tianjin Medical University from January 2017 to December 2018,developed urinary tract infection within 2 weeks after ureteral stenting(infection group).One hundred and sixty-eight patients with ureteral stenting and without urinary tract infection were matched by gender,age(within 3 years old)and catheterization time(30 d)as the control group.The Cox regression analysis was performed to identify the risk factors of urinary tract infection after ureteral stenting.The pathogenic distribution and drug resistance of the strains in the case group were analyzed.Results Univariate analysis showed that the use of hormones,multiple urinary stones,the size of stones≥2 cm in diameter,history of previous stones,residual stones after catheterization,urinary tract infections one month before catheterization,elevated peripheral blood leukocytes,and increased neutrophil proportion and decreased serum albumin were significantly associated with urinary tract infection after ureteral stent placement(all P<0.05).Cox multivariate analysis showed that the history of previous stones(OR=5.689,95%CI 1.944-16.652,P<0.01),residual stones after catheterization(OR=7.660,95%CI 3.371-17.409,P<0.01)and increased proportion of neutrophils(OR=5.586,95%CI 2.410-12.949,P<0.01)were independent risk factors for urinary tract infection after ureteral stent placement in urological patients.All 84 patients had single infection,and total 84 pathogens were isolated,of which Escherichia coli was most prevalent(28.57%,24/84).Escherichia coli has a high resistance rate to compound sulfamethoxazole,levofloxacin,ampicillin and ceftriaxone(all>60.00%);while the sensitivity rate of Escherichia coli to ertapenem,imipenem and tigecycline were all 100.00%,and the resistance rates to other antimicrobial agents were<30.00%.Conclusion Reducing the incidence and recurrence of urinary stones and the residual stones after surgery as well as the proportion of patients with neutrophils can decrease the risk of urinary tract infection in patients after ureteral stenting.Escherichia coli is the main pathogen causing urinary tract infection after ureteral stenting.