上尿路结石内镜手术后尿源性脓毒血症病原菌耐药及死亡高危因素分析

Analysis of pathogenic bacteria resistance of drug and high risk factors of death in urogenic sepsis after endoscopic surgery for upper urinary tract stones

目的分析上尿路结石内镜术后尿源性脓毒血症病原菌耐药特点及死亡的高危因素。方法回顾性分析2016年1月至2022年1月在赤峰学院附属医院采用内镜治疗的108例上尿路结石且术后发生尿源性脓毒血症患者的临床资料,根据预后分为死亡组及治愈组,分析其病原菌耐药性特点,同时采用多因素非条件Logistic回归模型从术前相关因素、手术相关因素、转入ICU后相关因素及病原菌相关因素四个方面分析上尿路结石内镜术后尿源性脓毒血症死亡的高危因素。结果死亡组和治愈组患者分别为21及87例。共培养出108株菌株,其中革兰氏阴性菌85株(78.70%)、革兰氏阳性菌21株(19.44%)、真菌2株(1.85%)。革兰氏阴性菌中排在前三位的依次为大肠埃希菌、粘质沙雷氏菌及铜绿假单胞菌,革兰氏阳性菌中前三位分别为粪肠球菌、屎肠球菌及金黄色葡萄球菌,真菌包括热带假丝酵母菌和白色假丝酵母菌。革兰氏阴性菌中产超广谱β-内酰胺酶(ESBLs)菌检出16株,革兰氏阳性菌中耐甲氧西林金黄色葡萄球菌(MRSA)检出4株。革兰氏阴性菌中,大肠埃希菌对头孢呋辛耐药率为88.57%,粘质沙雷菌对头孢呋辛及头孢噻肟耐药率最高均为83.33%,铜绿假单胞菌对左旋氧氟沙星耐药率为44.44%,革兰氏阳性菌对红霉素耐药率最高为100%。单因素分析结果显示,女性、糖尿病、自身免疫病、术前尿细菌培养阳性、手术时间、患者急性生理与慢性健康状况(APACHE II)评分、序贯器官衰竭(SOFA)评分及产ESBLs菌是上尿路结石术后尿源性脓毒血症死亡的相关因素,差异均有统计学意义(P<0.05),Logistic回归分析显示女性、糖尿病、自身免疫病、APACHE II评分、SOFA评分及产ESBLs菌是死亡的独立危险因素。结论上尿路结石内镜术后尿源性脓毒血症病原菌以革兰氏阴性菌为主且耐药率较高,女性、糖尿病、自身免疫病、APACHE II评分、SOFA评分及产ESBLs菌是该类患者死亡的高危因素。

ObjectiveTo analyze the characteristics of drug resistance and high risk factors of death of pathogenic bacteria of urogenic sepsis after endoscopic surgery for upper urinary tract calculi.MethodsThe clinical data of 108 patients with upper urinary tract calculi treated by endoscopy in the Affiliated Hospital of Chifeng University from January 2016 to January 2022 were analyzed retrospectively. They were divided into death group and cure group according to the prognosis. The characteristics of pathogen drug resistance were analyzed. At the same time, multivariate unconditional logistic regression model was used to analyze the high-risk factors of urogenic sepsis death after endoscopic surgery for upper urinary calculi, which was analyzed from four aspects: preoperative, surgical, ICU and pathogen related factors.ResultsThere were 21 patients in death group and 87 in the cure group. 108 strains were cultured, including 85 strains of gram-negative bacteria (78.70%), 21 strains of gram-positive bacteria (19.44%) and 2 strains of fungi (1.85%). The top three gram-negative bacteria were Escherichia coli, Serratia marcescens and Pseudomonas aeruginosa. The top three gram-positive bacteria were Enterococcus faecalis, Enterococcus faecium and Staphylococcus aureus. The fungi included Candida tropicalis and Candida albicans. 16 strains of extended-spectrum β lactamases (ESBLs) producing bacteria were detected in gram-negative bacteria, and 4 strains of Methicillin-resistant Staphylococcus aureus (MRSA) were detected in gram-positive bacteria. Among gram-negative bacteria, the drug resistance rate of Escherichia coli to Cefuroxime was 88.57%, the drug resistance rate of Serratia marcescens to Cefuroxime and Cefotaxime was 83.33%, the drug resistance rate of Pseudomonas aeruginosa to Levofloxacin was 44.44%, and the drug resistance rate of gram-positive bacteria to Erythromycin was 100%. Univariate analysis showed that female, diabetes, autoimmune diseases, preoperative bacterial positive urine, operation time, acute physiology and chronic health status (APACHE II) score, sequential organ failure assessment (SOFA) score and ESBLs producing bacteria were the related factors of death after urinary calculi surgery (P<0.05). Multivariate logistic regression analysis showed that female, diabetes, autoimmune disease, APACHE II score, SOFA score and ESBLs producing bacteria were independent risk factors for death.ConclusionsGram-negative bacteria are the main pathogens of urinary tract sepsis after endoscopic surgery for upper urinary tract calculi and the resistance rate is high. Female, diabetes, autoimmune diseases, APACHE II score, SOFA score and ESBLs producing bacteria are risk factors for death.