宫颈癌患者术后发生尿路感染的影响因素以及病原菌分布和耐药性分析

Analysis of influencing factors,pathogen distribution,and drug resistance of postoperative urinary tract infections in cervical cancer patients

目的分析宫颈癌患者术后尿路感染的病原菌分布情况及耐药性,并探讨术后发生尿路感染的危险因素。方法选取138例宫颈癌根治术后患者,对患者术后尿路感染的发生情况、病原菌分布情况进行分析,并检测病原菌的耐药性,宫颈癌患者术后发生尿路感染的影响因素采用多因素Logistic回归分析。结果138例宫颈癌患者术后发生尿路感染38例,感染发生率为27.54%(38/138)。38例尿路感染患者共培养出85株菌株,其中革兰阴性菌57株,占比67.06%,以大肠埃希菌、肺炎克雷伯菌为主;革兰阳性菌26株,占比30.59%,以粪肠球菌、表皮葡萄球菌为主;真菌2株,占比2.35%。大肠埃希菌对环丙沙星、氨苄西林、头孢唑林、四环素、妥布霉素、头孢拉定、氨曲南、阿莫西林、左氧氟沙星、头孢他啶、头孢曲松、庆大霉素的耐药性较高;肺炎克雷伯菌对头孢唑林、呋喃妥因、头孢曲松的耐药性较高。粪肠球菌对万古霉素、氨苄西林、呋喃妥因、利奈唑胺的耐药性较低;表皮葡萄球菌对环丙沙星、庆大霉素的耐药性较高。Logistic多因素回归分析结果显示,年龄≥60岁、住院时间>15天、尿管留置时间>7天、有糖尿病、术后尿潴留均为宫颈癌患者术后发生尿路感染的独立危险因素(P<0.05)。结论宫颈癌患者术后尿路感染的病原菌以革兰阴性菌为主,且对二、三代头孢类抗生素和喹诺酮类药物具有一定的耐药性,临床应加强对抗生素应用的合理性;此外,术后尿路感染的发生受多种因素的影响,临床应加强针对性防治工作。

Objective To analyze the distribution and drug resistance of pathogenic bacteria in postoperative urinary tract infections in cervical cancer patients,and explore the risk factors of postoperative urinary tract infections.Method A total of 138 patients with cervical cancer undergoing radical surgery were selected to analyze the incidence and distribution of postoperative urinary tract infections,as well as the drug resistance of pathogens.The influencing factors of postoperative urinary tract infections in cervical cancer patients were analyzed using multivariate Logistic regression analysis.Result There were 38 cases of urinary tract infection in 138 patients with cervical cancer,and the infection rate was 27.54%(38/138).A total of 85 strains were cultured,of which 57 strains(67.06%)were Gram-negative bacteria,mainly escherichia coli and klebsiella pneumoniae,26 strains(30.59%)were Gram-positive bacteria,mainly the enterococcus faecalis,staphylococcus epidermidis and 2 strains(2.35%)were fungi.The resistance of escherichia coli to ciprofloxacin,ampicillin,cefzolin,tetracycline,tobramycin,cefradine,amtriaxam,amoxicillin,levofloxacin,ceftazidine,ceftriaxone and gentamicin were high;the resistance of klebsiella pneumoniae to cefazolin,furantoin and ceftriaxone were high;the resistance of enterococcus faecalis to vancomycin,ampicillin,furantoin and linezolid were low;staphylococcus epidermidis showed high resistance to ciprofloxacin and gentamicin.Logistic multivariate regression analysis showed that age≥60 years,hospital stay>15 days,catheter retention>7 days,diabetes and postoperative urinary retention were independent risk factors for postoperative urinary tract infection in cervical cancer patients(P<0.05).Conclusion The main pathogenic bacteria for postoperative urinary tract infections in cervical cancer patients are Gram negative bacteria,and they have certain resistance to second-generation and third-generation cephalosporins and quinolones.Therefore,the rationality of antibiotic application should be strengthened in clinical practice.In addition,the occurrence of postoperative urinary tract infections is influenced by multiple factors,and targeted prevention and treatment work should be strengthened in clinical practice.