脊髓损伤患者泌尿系感染的危险因素与病原学分析

目的:分析脊髓损伤患者住院期间并发泌尿系感染的危险因素与病原菌,为防治泌尿系感染提供依据。方法:回顾性分析2012年1月~2016年10月,我科收治的237例脊髓损伤患者并发泌尿系感染的相关因素与病原菌情况,先采用单因素logistic回归分析患者的性别、年龄、病程,是否有糖尿病、高血压、心脏病等慢性病史,是否合并肺部感染、压疮、电解质紊乱、低蛋白血症等并发症,是否合并脊柱骨折、是否行手术治疗、早期有无使用大剂量激素治疗、是否行早期康复干预、是否采取持续留置导尿、清洁间歇导尿、无菌间歇导尿、耻骨上膀胱造瘘术等治疗,是否行会阴擦洗、膀胱冲洗、健康教育等护理措施,是否完全性脊髓损伤、脊髓休克期与恢复期等相关因素,初步筛选可疑危险因素,再进行多因素logistic回归分析,筛选脊髓损伤患者并发泌尿系感染的独立危险因素。结果:患者年龄≥50岁、留置导尿2~6周、糖尿病史、早期应用大剂量激素、脊柱骨折、完全性损伤、脊髓损伤休克期为泌尿系感染的独立危险因素,健康教育、无菌间歇导尿为保护性因素(均P0.05);病原菌以大肠埃希氏菌为主,其次为肺炎克雷伯杆菌、屎肠球菌、粪肠球菌、阴沟肠杆菌、白色念珠菌等。结论:建议依据脊髓损伤患者并发泌尿系感染的危险因素和病原菌情况,采取措施,防治泌尿系感染。

Risk factors and pathogens for urinary tract infection in spinal cord injury patients

Objective: By analyzing the risk factors and pathogens for urinary tract infection in spinal cord injury patients concurrent with urinary tract infection during the period of hospitalization, to provide a basis for preventing the urinary tract infection in spinal cord injured patients. Methods: We retrospectively analyzed the related factors and pathogens of 237 cases of spinal cord injury patients concurrent with urinary system infection treated in our department between January 2012 to October 2016. First, single-factor logistic regression was used to analyze the patients'' gender, age, disease course, whether suffering from diabetes, hypertension, heart disease and other chronic diseases, whether suffering from pulmonary infection, pressure sores, electrolyte imbalance, hypoalbuminemia and other complications, whether suffering from spine fracture, whether receiving surgical treatment, early application of high-dose steroid hormone, whether taking early rehabilitation intervention, whether taking continuous indwelling catheterization, clean intermittent catheterization, sterile intermittent catheterization, suprapubic cystostomy and other treatment, whether taking perineal scrub, bladder irrigation, health education and other nursing measures, whether having complete spinal cord injury, whether in the period of spinal cord shock or recovery period and other related factors. The suspected risk factors were initially screened, and then multivariate logistic regression analysis was used to screen early spinal cord injury patients with UTI independent risk factors. Results: Age greater than 50, indwelling catheterization for 2-6 weeks, diabetes mellitus, early application of high-dose steroid hormone, spine fracture, complete injury, and shock period were the independent risk factors of urinary tract infection. Health education, and sterile intermittent catheterization were the protective factors (P<0.05). The main pathogens included Escherichia coli, followed by Klebsiella pneumoniae, Enterococcus faecalis, Enterobacter cloacae, Candida albicans. Conclusion: According to the risk factors of urinary tract infection and pathogenic bacteria in patients with spinal cord injury, it is recommended to take measures to prevent urinary tract infections.