宫颈癌术后导尿管相关尿路感染病原菌及其影响因素分析

Pathogens and influencing factors of catheter associated urinary tract infection after cervical cancer surgery

目的 分析宫颈癌术后导尿管相关尿路感染病原菌分布及导致感染发生的影响因素。方法 选择2020年2月~2022年6月间接受宫颈癌根治术治疗的患者152例作为研究对象,采集留置导尿管24 h后尿液标本检测病原菌,统计导管相关尿路感染发生率,按照是否感染分为感染组和未感染组,采用单因素和多因素Logistic回归分析法分析导管相关尿路感染可能的影响因素。结果 152例宫颈癌手术患者术后发生导管相关尿路感染47例,发生率为30.92%,共分离出病原菌68株,其中革兰阴性菌41株,占60.29%,革兰阳性菌24株,占35.29%,真菌3株,占4.41%。导管相关尿路感染主要革兰阴性菌(大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌)和主要革兰阳性菌(粪肠球菌、金黄色葡萄球菌)对常用抗菌药物均具有一定的抗药性。单因素分析结果显示,年龄、合并糖尿病、留置导管时间、置管次数、导尿管置入方法、术后卧床时间、住院时间、抗菌药物使用种类是导致宫颈癌患者术后导管相关尿路感染的危险因素(P<0.05)。以单因素分析中差异有统计学意义的相关因素为自变量,宫颈癌术后发生导管相关尿路感染为因变量,代入多因素Logistic回归分析,结果显示,年龄>60岁、合并糖尿病、留置导管时间>7 d、置管次数>1次、导尿管置入无菌原则不严格、抗菌药物使用种类>3种是导致宫颈癌患者术后导管相关尿路感染的独立危险因素。结论 革兰阴性菌是导致宫颈癌术后感染的主要致病菌,感染的发生与年龄、合并糖尿病、长时间置管、多次置管、无菌操作不严格、抗菌药物滥用有关。

Objective To analyze the distribution of pathogenic bacteria in catheter associated urinary tract infection after cervical cancer surgery and the influencing factors leading to infection.Methods 152 patients who received radical surgery for cervical cancer in hospital from February 2020 to June 2022 were selected as research objects.Urine samples were collected 24 hours after indwelling catheter to detect pathogens,and the incidence of catheter related urinary tract infection was counted.They were divided into infected group and uninfected group according to whether they were infected or not.The possible influencing factors of catheter related urinary tract infection were analyzed by single factor and multi factor Logistic regression analysis.Results There were 47 cases of catheter related urinary tract infection in 152 patients with cervical cancer after surgery,the incidence rate was 30.92%.A total of 68 strains of pathogenic bacteria were isolated,including 41 strains of Gram negative bacteria,accounting for 60.29%,24 strains of Gram positive bacteria,accounting for 35.29%,and 3 strains of fungi,accounting for 4.41%.The main gram-negative bacteria(Escherichia coli,Pseudomonas aeruginosa,Klebsiella pneumoniae)and the main gram-positive bacteria(Enterococcus faecalis,Staphylococcus aureus)of catheter related urinary tract infection had certain resistance to commonly used antibiotics.The results of univariate analysis showed that age,diabetes,indwelling catheter time,indwelling catheter frequency,catheter insertion method,postoperative bed rest time,hospital stay,and the type of antibiotics used were the risk factors for postoperative catheter related urinary tract infection in patients with cervical cancer(P<0.05).The statistically significant correlation factors in the univariate analysis were taken as independent variables,and the occurrence of catheter related urinary tract infection after cervical cancer surgery was taken as dependent variable.Multifactor logistic regression analysis was used.The results showed that age>60 years old,combined with diabetes,catheter indwelling time>7 days,catheter indwelling times>1 time,and the sterile principle of catheter indwelling was not strict.The use of more than three kinds of antibacterial drugs is an independent risk factor for postoperative catheter-related urinary tract infection in patients with cervical cancer.Conclusion Gram negative bacteria were the main pathogenic bacteria that cause catheter related urinary tract infection after cervical cancer surgery.The incidence of infection was related to age,diabetes,prolonged catheterization,multiple catheterization,lax aseptic operation,and abuse of antibiotics.