宫颈癌患者术后泌尿系统大肠埃希菌感染危险因素及其耐药性

Risk factors for postoperative urinary tract Escherichia coli infection in cervical cancer patients and risk factors

目的 探究宫颈癌根治术后泌尿系统感染大肠埃希菌的耐药性及其危险因素。方法 选择2019年4月-2022年7月重庆两江新区人民医院收治的104例宫颈癌根治术后泌尿系统大肠埃希菌感染患者为感染组,分析大肠埃希菌耐药性。并以同期未出现泌尿系统感染的宫颈癌根治术治疗患者104例为对照组,统计两组患者的临床资料,归纳患者术后泌尿系统感染的危险因素。结果 宫颈癌根治术后泌尿系统感染495例,其中大肠埃希菌感染率为21.01%(104/495),标本采集合格率为98.11%(104/106);104株大肠埃希菌的耐药表型中,野生型占比高于产超广谱β内酰胺酶(ESBLs)(CTX-M型)、产耐酶抑制剂青霉素酶型、氨基糖苷类耐药型及高产头孢菌素酶型,ESBLs(非CTX-M型)占比高于产耐酶抑制剂青霉素酶型、氨基糖苷类耐药型、高产头孢菌素酶型(P<0.05);野生型对常用抗菌药物的耐药率均较低,ESBLs(CTX-M型)、ESBLs(非CTX-M型)、产耐酶抑制剂青霉素酶型、氨基糖苷类耐药型大肠埃希菌对氨苄西林、头孢曲松等耐药率较高;年龄、开腹手术、尿管留置时间、合并糖尿病、术后出现尿潴留是宫颈癌根治术后泌尿系统感染的危险因素,预防性使用抗菌药物为保护因素(P<0.05)。结论 宫颈癌根治术后泌尿系统感染大肠埃希菌耐药表型主要为ESBLs型,各耐药表型对氨苄西林、头孢曲松等耐药率均较高,且年龄、开腹手术、尿管留置时间、合并糖尿病、术后尿潴留等可增加宫颈癌根治术后泌尿系统感染发生风险。

OBJECTIVE To investigate the drug resistance of Escherichia coli and risk factors of urinary system infection after radical resection of cervical cancer.METHODS A total of 104 patients with Escherichia coli infection in the urinary system after radical resection of cervical cancer in People′s Hospital of Chongqing Liang Jiang New Area were selected as the infection group between Apr.2019 and Jul.2022.The drug resistance of Escherichia coli was analyzed.And 104 patients treated with radial cervical cancer surgery without urinary system infection during the same period were selected as the control group.The clinical data in the two groups were statistically analyzed,and the risk factors of urinary system infection in the postoperative period were summarized.RESULTS There were 495 cases with urinary system infection after radical resection of cervical cancer,of which the infection rate of Escherichia coli was 21.01%(104/495),and qualification rate of samples collection were and 98.11%(104/106).Among the 104 strains of resistance phenotypes of Escherichia coli,the proportion of wild type was higher than that of extended-spectrum β-lactamases(ESBLs)-producing type(CTX-M type),enzyme-resistant inhibitor penicillinase-producing type,aminoglycoside-resistance type and high-yielding cephalosporinase type.The proportion of ESBLs(non-CTX-M type) was higher than that of enzyme-resistant inhibitor penicillinase-producing type,aminoglycoside-resistance type and high-yielding cephalosporinase type(P<0.05).All wild type strains had low resistance rates to commonly used antibiotics,while Escherichia coli of ESBLs(CTX-M type),ESBLs(non-CTX-M type),enzyme-resistant inhibitor penicillinase-producing type and aminoglycoside-resistance type had higher resistant rates to ampicillin and ceftriaxone.Age,laparotomy,catheter indwelling time,diabetes and postoperative urinary retention were risk factors of urinary system infection after radical resection of cervical cancer,while prophylactic use of antibiotics was a protective factor(P<0.05).CONCLUSION The drug-resistance phenotypes of Escherichia coli after radical resection of cervical cancer were mainly ESBLs,and the resistance rates of each drug-resistant phenotypes to ampicillin and ceftriaxone was high.Advanced age,laparotomy,catheter indwelling time,diabetes and postoperative urinary retention could increase the risk of urinary system infection after radical resection of cervical cancer.