妇科手术患者导尿管相关性尿路感染的危险因素分析

Risk factors analysis of catheter-associated urinary tract infection in patients undergoing gynecological surgery

目的分析妇科手术患者术后导尿管相关尿路感染病原菌及其影响因素,为医院感染的预防和控制工作提供参考。方法采用回顾性研究方法,将2017年1月1日至2018年12月31日在广东省中医院行妇科手术的住院患者3825例作为研究对象,年龄(42.31±12.44)岁,通过查阅病历对患者术后尿路感染的发生情况、病原菌及其影响因素进行分析。结果术后患者发生尿路感染率为1.69%(134/7923),在患者尿样中共检出病原菌136株,包括革兰阳性菌(24株)、革兰阴性菌(103株)及真菌(9株)。多元logistic回归分析结果显示是否有尿路侵入性操作、肿瘤、尿管留置天数、住院天数均为尿路感染发生的影响因素。结论革兰阴性菌是导致宫颈癌术后尿路感染的主要病原菌,感染的发生与有尿路侵入性操作、肿瘤、尿管留置天数、住院天数有关,临床管理过程中应该从控制尿管留置时间、规范日常护理、提高营养状态、实施全流程标准化管理4个方面进行。

Objective To analyze the pathogens and their influencing factors of postoperative catheter-related urinary tract infection in patients undergoing gynecological surgery,and to provide a reference for the prevention and control of nosocomial infection.Methods A total of 3825 inpatients undergoing gynecological surgery in Guangdong Hospital of Traditional Chinese Medicine from January 1,2017 to December 31,2018 were selected,with an age of(42.31±12.44)years old.The postoperative urinary tract infection,pathogens,and influencing factors were analyzed through medical records.Results The incidence of postoperative urinary tract infection was 1.69%(134/7923),and 136 pathogens were detected,including 24 strains of Gram positive bacteria,103 strains of gram negative bacteria,and 9 strains of fungi.The results of multiple logistic regression analysis showed that urinary tract invasive operation,tumor,duration of catheter retention,and length of hospital stay were the influencing factors for the occurrence of urinary tract infection.Conclusions Gram-negative bacteria are the main pathogenic bacteria that cause urinary tract infection after cervical cancer surgery.The occurrence of infection is related to urinary tract invasive operation,tumor,duration of catheter retention,and length of hospital stay.Clinical management should be carried out from four aspects:controlling catheter indwelling time,standardizing daily nursing,improving nutritional status,and implementing full-process standardized management.