膀胱肿瘤切除术后尿路感染病原学和危险因素

目的观察膀胱肿瘤切除术后患者尿路感染发生情况与病原学特征,分析诱发尿路感染的危险因素,并提出合理且具备针对性的冲洗对策,为未来膀胱肿瘤切除术后尿路感染的预防提供合理参考。方法回顾性分析连云港市第一人民医院2016年1月-2019年1月接受经尿道膀胱肿瘤切除术治疗的451例膀胱肿瘤患者的临床资料,收集患者病例资料,全部患者术后均定期取尿液标本进行细菌培养,参照相关标准判定患者尿路感染情况,记录患者一般情况,包括一般人口学资料(性别、年龄、体质量、受教育程度等),同时记录患者糖尿病的疾病合并情况,将术后尿路感染可能的危险因素纳入初步分析,Logistic多因素回归分析膀胱肿瘤切除术后发生尿路感染的危险因素。结果451例膀胱肿瘤切除术患者术后第3天尿液中细菌培养阳性例数为80例,阳性率为17.74%,在使用抗菌药物后,患者尿液中细菌培养阳性率逐渐降低,各时点尿液细菌阳性培养率比较,差异有统计学意义(P<0.05);经多因素Logistic回归分析检验证实,高龄、血糖水平控制不佳、术前留置导尿管、多发肿瘤是膀胱肿瘤切除术后尿路感染的危险因素(OR>1,P<0.05);80例术后尿液细菌培养阳性患者共分离出87株菌株,其中革兰阴性菌66株占75.86%,革兰阳性球菌21株占24.14%。结论膀胱肿瘤切除术后患者有较高的尿路感染风险,革兰阴性菌是主要的感染病原菌,年龄、基础疾病、肿瘤位点、术前导尿管留置等是影响因素,这类患者应引起临床高度重视。

Risk factors and etiological features of urinary tract infection after resection of bladder tumor

OBJECTIVE To observe the occurrence and pathogenic features of urinary tract infection after resection of bladder tumor,and to analyze the risk factors of urinary tract infection,in order to put forward reasonable and targeted washing countermeasures,and to provide reference for prevention of urinary tract infection after resection of bladder tumor.METHODS The clinical data of 451 bladder tumor patients with resection of bladder tumor in Lianyungang first people’s hospital from January 2016 to January 2019 were retrospectively analyzed.The medical data of patients were collected.All patients were regularly taken urine samples for bacterial culture,and the urinary tract infection was determined according to relevant criteria.The general situations of patients were recorded,including general demographic data(gender,age,body mass,educational level,etc.),and the disease combination of diabetes mellitus in patients was recorded.The possible risk factors of postoperative urinary tract infection were included,and the chi-square test was used for preliminary analysis.The variables with significant differences in chi-square test were further confirmed by multiple Logistic regression analysis,so as to analyze the risk factors of urinary tract infection after resection of bladder tumor.RESULTS Among 451 patients with resection of bladder tumor,there were 80 cases of positive bacterial culture in the urine after surgery for 3 d,and the positive rate was 17.74%.After the use of antibiotics,the positive rate of bacterial culture in urine decreased gradually,and the positive rate of bacterial culture was significant at each time(P<0.05).The multiple Logistic regression analysis confirmed that advanced age,poor control of blood glucose level,preoperative indwelling catheter,multiple tumors may be the risk factors for urinary tract infection after resection of bladder tumor(OR>1,P<0.05).A total of 87 strains were isolated from 80 patients with positive urine culture after surgery:66 strains were Gram-negative bacilli,accounting for 75.86%;21 strains were Gram-positive cocci,accounting for 24.14%.CONCLUSION Patients with resection of bladder tumor had a higher risk of urinary tract infection,and Gram-negative bacteria were the main infectious pathogens.Age,underlying disease,tumor site,and preoperative catheter indwelling were influencing factors.These patients should be highly regarded in the clinic.