神经外科不同病原菌医院获得性尿路感染的临床特征分析

Analysis of clinical characteristics of nosocomial acquired urinary tract infection caused by different pathogenic bacteria in neurosurgery

目的探讨革兰阳性菌(G+菌)、革兰阴性菌(G-菌)和真菌所致神经外科患者医院获得性尿路感染的临床特征。方法回顾分析2017年1月至2019年12月本院神经外科发生医院获得性尿路感染127例患者的相关临床资料,按病原菌不同分为G+菌组、G-菌组和真菌组,研究3组患者性别、年龄、原发疾病、格拉斯哥(GCS)评分、合并症、易感因素、手术情况及实验室检查,统计分析比较各组间差异。结果3组患者性别构成、年龄、原发病构成、各种合并症比例、尿常规pH值、尿白细胞酯酶阳性比例、血降钙素原水平、血白细胞异常、血小板异常、使用升压药的比例比较差异均无统计学意义(均P>0.05)。G-菌组尿常规白细胞计数高于G+菌组和真菌组,而真菌组GCS评分较其他两组低,而先前手术、合并其他感染的比例较其他两组高(均P<0.05)。结论神经外科不同病原菌医院获得性尿路感染的临床表现及实验室辅助检查特点有所不同,可为早期经验性判断提供一定依据,但缺乏特异性指标,鉴别致病菌仍需结合病情综合评估。

Objective To investigate the clinical characteristics of nosocomial acquired urinary tract infection in neurosurgical patients caused by gram-positive bacteria(G+bacteria),gram-negative bacteria(G-bacteria),and fungi.Methods Clinical data of 127 patients with nosocomial acquired urinary tract infection in neurosurgery of our hospital from January 2017 to December 2019 were retrospectively analyzed,who were divided into the G+bacteria group,Gbacteria group,and fungi group according to the different pathogens.The gender,age,primary diseases,Glasgow(GCS)score,complications,risk factors,the operation situation,and laboratory examination were compared among the three groups.Results There were no statistically significant differences among the three groups in gender,age,composition of primary diseases,proportion of various complications,urine routine pH value,urine leucocyte esterase positive proportion,blood calcitonin level,abnormal blood leucocyte,abnormal platelet,and proportion of using vasopressor drugs(all P>0.05).The routine urine white blood cell count of the G-bacteria group was higher than those of the G+bacteria group and the fungi group,while the GCS score of the fungi group was lower than those of the other two groups,and the proportion of patients with previous surgery and other infections were higher than those of the other two groups(all P<0.05).Conclusions The clinical manifestations and laboratory-assisted examination characteristics of nosocomial acquired urinary tract infection caused by different pathogenic bacteria in neurosurgery are different,which can provide certain basis for early empirical judgment.However,specific indicators are not available,and the identification of pathogenic bacteria still needs to be comprehensively evaluated in combination with the condition.