妇科恶性肿瘤患者导尿管相关性泌尿道感染危险因素分析

目的探讨某院妇科恶性肿瘤手术患者导尿管相关性泌尿道感染（CAUTI）的发病情况和危险因素。方法采用前瞻性和回顾性调查方式，对该院2010 年7月-2011 年12月妇科恶性肿瘤手术留置导尿管患者进行调查，并对发生CAUTI的危险因素进行分析。结果共调查353例患者，发生CAUTI 62例，CAUTI发生率为17.56%；置管日为2 292 d，平均日感染率为27.05/千导管日。logistic多变量回归分析显示，子宫颈恶性肿瘤（OR 95% CI：1.791～8.269）和留置导尿管时间（OR 95% CI：2.823～8.735）是妇科恶性肿瘤患者发生CAUTI的独立危险因素。检出病原菌60株，革兰阴性杆菌占90.00%（54/60），其中以大肠埃希菌（44株，73.33%）为主。结论该院妇科恶性肿瘤手术患者CAUTI发病率较高；提高手术医生的手术技巧和护理人员对导尿管维护的质量,尽早拔除导尿管，是预防CAUTI发生的关键。

Risk factors for catheter associated urinary tract infection in patients with gynecologic malignant tumor

Objective To evaluate the incidence rate and risk factors for catheter-associated urinary tract infection （CAUTI） in patients with gynecologic malignant tumor surgery. Methods A prospective and retrospective investiga- tion was carried out on patients who received indwelling urinary catheter after gynecologic malignant tumor surgery from July 2010 to December 2011, and the risk factors for CAUTI were analyzed. Results A total of 353 patients who received indwelling urinary catheter after gynecologic malignant tumor surgery were investigated, 62 cases suf- fered from CAUTI, the infection rate was 17. 56% the duration of catheter use was 2 292 days, and the average in- cidence rate was 27. 05 per 1 000 catheter days. Multivariate logistic regression analysis showed that cervical cancer （OR 95% CI： 1. 791 - 8. 269） and the duration of catheterization（OR 95% CI：2. 823 - 8. 735） were the independent risk factors for CAUTI in inpatients with indwelling urinary catheter after surgery. A total of 60 pathogenic isolates were detected, 90. 00%（54/60） were gram-negative bacilli,the top one was Escherichia coli（44 isolates,73. 33%）. Conclusion The incidence rate of CAUTI is high in patients with gynecologic malignant tumor surgery in this hos- pital, which can be reduced by improving skill in surgery and quality for urinary catheter care, and removing catheter timely.