经尿道前列腺切除术后尿路感染的危险因素及病原菌分布

Risk factors and distribution of pathogenic bacteria of urinary tract infection after transurethral resection of prostate

目的探讨经尿道前列腺电切术(TURP)后尿路感染的危险因素及病原菌构成特征。方法回顾性收集某院泌尿外科良性前列腺增生行TURP患者的临床资料,采用单因素和多因素logistic回归分析TURP术后尿路感染的危险因素,并分析患者尿标本中病原菌构成情况。结果155例接受TURP患者中,24例患者(15.5%)发生术后尿路感染。单因素分析结果显示,尿路感染组与非感染组患者年龄、前列腺大小、术前留置导尿管,曾行泌尿道医疗操作、糖尿病史、电切镜鞘尺寸、手术时间和灌洗液温度各项比较,差异均有统计学意义(均P<0.05);多因素logistic回归分析结果显示,患者的年龄>65岁(OR=4.18,95%CI:1.19~14.75,P=0.026)、前列腺>55 g(OR=3.92,95%CI:1.11~13.83,P=0.034)、术前留置导尿管(OR=0.28,95%CI:0.11~0.70,P=0.006)、曾行泌尿道医疗操作(OR=4.70,95%CI:1.85~11.94,P=0.001)、有糖尿病史(OR=2.54,95%CI:1.00~6.48,P=0.050)、电切镜鞘尺寸26F(OR=9.05,95%CI:1.18~69.48,P=0.034)、手术时间>60 min(OR=10.48,95%CI:1.37~80.25,P=0.024)和灌洗液温度<37℃(OR=4.06,95%CI:1.57~10.50,P=0.004)是TURP术后尿路感染的独立危险因素。感染患者尿标本共检出病原菌23株,主要为革兰阴性菌(78.26%),其中大肠埃希菌占比达52.17%(12株)。结论TURP术后尿路感染与手术时间、电切镜鞘尺寸、曾有泌尿道医疗操作、前列腺大小等相关,感染病原菌仍以大肠埃希菌为主,有效避免高危因素及合理预防性使用抗菌药物,可有助于预防TURP术后尿路感染的发生。

Objective To analyze risk factors and constituent pattern of pathogenic bacteria of urinary tract infection(UTI)after transurethral resection of prostate(TURP).Methods Clinical data of patients with benign prosta-tic hyperplasia undergoing TURP in department of urological surgery of a hospital were retrospectively analyzed,univariate and multivariate logistic regression analysis was used to analyze the risk factors for UTI after TURP,constituent of pathogenic bacteria in urine specimens was analyzed.Results Of 155 patients receiving TURP,24(15.5%)developed post-operative UTI.Univariate analysis showed that patients with UTI and patients without infection were significantly different in age,prostate size,pre-operative urinary catheterization,previous urological intervention,history of diabetes mellitus,size of resectoscope sheath,duration of operation,and temperature of irrigation fluid(all P<0.05);multivariate logistic regression analysis revealed that patients’age>65 years(OR=4.18,95%CI:1.19-14.75,P=0.026),prostate weight>55 g(OR=3.92,95%CI:1.11-13.83,P=0.034),pre-operative urinary catheterization(OR=0.28,95%CI:0.11-0.70,P=0.006),previous urological intervention(OR=4.70,95%CI:1.85-11.94,P=0.001),history of diabetes mellitus(OR=2.54,95%CI:1.00-6.48,P=0.050),resectoscope sheath size=26F(OR=9.05,95%CI:1.18-69.48,P=0.034),duration of operation>60 minutes(OR=10.48,95%CI:1.37-80.25,P=0.024),and temperature of irrigation fluid<37℃(OR=4.06,95%CI:1.57-10.50,P=0.004)were independent risk factors for UTI after TURP.A total of 23 strains of pathogenic bacteria were isolated from urine specimens of infected patients,mainly Gram-negative bacteria(78.26%),Escherichia coli accounted for 52.17%(n=12).Conclusion UTI after TURP is associated with duration of operation,size of resectoscope sheath,previous urological intervention,and prostate size,Escherichia coli is the main pathogen of infection,effective prevention of high-risk factors and rational use of antimicrobial agents can reduce the occurrence of UTI after TURP.