腹腔镜根治性膀胱切除术后泌尿系感染与输尿管支架管关系的研究

Study on the relationship between urinary tract infection and ureteral stent after laparoscopic radical cystectomy

目的:初步探讨输尿管支架管拔除后泌尿系感染的危险因素,并总结病原菌谱及其敏感药物。方法:采用前瞻性随机队列研究方法,将2019年8月—2022年10月在北京协和医院进行腹腔镜根治性膀胱切除术及肠道尿流改道术的60例患者分为试验组和对照组,每组30例。试验组拔管时预防性使用抗生素,对照组未使用。通过logistic回归分析拔管后泌尿系感染的危险因素,观察并描述药敏实验结果的差异,总结术后感染的发生规律。结果:在试验组中,导管尖端培养呈阳性的患者17例(56.67%),最终发生感染的患者8例(26.67%);而在对照组中,导管尖端培养呈阳性的患者19例(63.33%),实际发生感染的患者14例(46.67%)。在拔管后6 h内应用碳青霉烯类抗生素可以显著降低拔管后尿路感染的风险(P=0.038,OR=2.414)。体重指数增大、糖尿病史、术前白蛋白水平降低以及术后返回ICU被确定为拔管后尿路感染的独立危险因素。拔管后尿路感染的主要病原菌为大肠埃希菌和肠球菌。拔管后进行血培养以寻找致病菌存在一定的假阳性率和滞后性。结论:拔管时应用碳青霉烯抗生素可以有效降低尿路感染的发生风险。对于进行根治性膀胱切除并进行肠道尿流改道的患者,建议在拔管同时进行导管尖端培养和药敏检测,以指导后续治疗。

Objective To preliminarily investigate the risk factors in urinary tract infection(UTI)following the removal of ureteral stent,and to summarize the spectrum of pathogens and their sensitive drugs.Methods A prospective randomized grouping method was employed to conduct a case series study on 60 patients who underwent laparoscopic radical cystectomy in Peking Union Medical College Hospital from Aug.2019 to Oct.2022.Logistic regression analysis was used to identify the risk factors in UTI after stent removal.Differences in antimicrobial sensitivity test results were observed and described,and the patterns of postoperative infections were summarized.Results In the experimental group,17 patients(56.67%)had positive cultures at the tip of the catheter,and 8 patients(26.67%)eventually developed infections.In the control group,19 patients(63.33%)had positive cultures,and 14 patients(46.67%)developed infections.The application of carbapenem antibiotics within 6 hours after stent removal significantly reduced the risk of post-removal UTI(P=0.038,OR=2.414).Increased body mass index,a history of diabetes,decreased preoperative albumin levels,and postoperative return to the ICU were identified as independent risk factors in UTI after stent removal.The most common pathogens causing UTI after stent removal were Escherichia coli and Enterococcus.Blood cultures conducted after stent removal to identify pathogens had a certain false-positive rate and delayed detection.Conclusion The use of carbapenem antibiotics during stent removal effectively reduces the risk of post-removal UTI.For patients undergoing radical bladder resection with diversion of intestinal urine flow,it is recommended to conduct catheter tip cultures and antimicrobial sensitivity tests simultaneously with stent removal to guide subsequent treatment.