输尿管软镜钬激光碎石术后医院感染病原学及危险因素

Risk factors and etiological characteristics of postoperative nosocomial infections in patients undergoing ureteral flexible holmium laser lithotripsy

目的探究输尿管软镜钬激光碎石术后医院感染危险因素及病原学特征。方法回顾性分析中国人民解放军联勤保障部队第九二八医院2021年2月—2022年12月收治的479例输尿管软镜钬激光碎石术后患者临床资料,根据术后是否发生医院感染,分为感染组51例和非感染组428例,统计感染病原学特征及感染部位分布;通过多因素Logistic分析输尿管软镜钬激光碎石术后医院感染发生的危险因素。结果479例输尿管软镜钬激光碎石术后医院感染发生51例,发生率为10.65%;51例感染患者检出病原菌59株,包括革兰阴性菌37株(62.71%)、革兰阳性菌17株(28.81%)和真菌5株(8.47%),感染组以泌尿系统感染患者占比最高(56.86%);多因素Logistic分析结果显示,术前合并尿路感染、合并糖尿病、手术时间>60 min、未预防性应用抗菌药物、尿管留置时间>7 d是输尿管软镜钬激光碎石术后医院感染发生的危险因素(OR=2.737、3.111、2.540、2.754、2.735,P<0.05)。结论输尿管软镜钬激光碎石术后医院感染发生率较高,感染部位以泌尿系统为主,病原菌以革兰阴性菌为主;术后医院感染与术前合并尿路感染、糖尿病史、手术时间、预防性应用抗菌药物、尿管留置时间有关,临床可据此采取早期针对性干预措施。

OBJECTIVE To explore the risk factors and etiological characteristics of postoperative nosocomial infec-tions in the patients undergoing ureteral flexible holmium laser lithotripsy.METHODS The clinical data were col-lected from 479 patients who underwent ureteral flexible holmium laser lithotripsy in 928 Hospital of People's Lib-eration Army Joint Service Support Force from Feb 2021 to Dec 2022 and were retrospectively analyzed,the en-rolled patients were divided into the infection group with 51 cases and the non-infection group with 428 cases ac-cording to the status of postoperative nosocomial infection.The etiological characteristics of the infections and the infection sites were statistically analyzed.Multivariate logistic analysis was performed for the risk factors for the postoperative nosocomial infections.RESULTS Among the 479 patients who underwent the ureteral flexible holmi-um lithotripsy,51 had postoperative nosocomial infections,with the incidence rate 10.65%.Totally 59 strains of pathogens were isolated from the 51 patients with infections,37(62.71%)of which were gram-negative bacteria,17(28.81%)were gram-positive bacteria,and 5(8.47%)were fungi.The patients who had urinary system in-fections were dominant among the patients with the infections,accounting for 56.86%.The result of multivariate logistic analysis showed that preoperative complication with urinary tract infection,complication with diabetes mellitus,operation duration more than 60 min,no prophylactic use of antibiotics and urinary catheter indwelling time more than 7 days were the risk factors for the postoperative nosocomial infections in the patients undergoing ureteral flexible holmium laser lithotripsy(OR=2.737,3.111,2.540,2.754,2.735,P<0.05).CONCLUSION The incidence of postoperative nosocomial infections is high among the patients undergoing ureteral flexible holmi-um laser lithotripsy,the urinary system is the major infection site.The gram-negative bacteria are dominant a-mong the pathogens.The incidence of postoperative nosocomial infections is associated with the preoperative com-plication with urinary tract infection,history of diabetes mellitus,operation duration,prophylactic use of antibiot-ics and urinary catheter indwelling time.It is necessary for the hospital to take targeted intervention measures in early stage.