输尿管结石患者经输尿管软镜取石术后发生院内感染的危险因素及预防措施
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摘要
目的探讨输尿管结石患者经输尿管软镜取石术后发生医院感染的危险因素及预防措施。方法选取2015年5月—2017年5月于杭州市第三人民医院行输尿管软镜取石术后发生医院感染的输尿管结石患者97例。对患者清洁尿液进行病原菌培养,分析病原菌的类别和耐药率,并对引发院内感染的危险因素进行分析。结果97例感染患者中共检出141株病原菌,其中革兰阴性菌96株(68.09%),以大肠埃希菌为主,占28.13%,革兰阳性菌45株(31.91%),以粪肠球菌为主,占42.22%。对主要病原菌进行耐药性分析,大肠埃希菌对庆大霉素的耐药率最高,对亚胺培南敏感性较高;粪肠球菌对青霉素的耐药性最高,粪肠球菌对万古霉素、呋喃妥因敏感性较高。97例发生医院感染的患者中,医源性感染7例,伤口护理不当感染45例,泌尿生殖道上行感染32例,其他原因13例。术后出血、术后疼痛、结石残余以及术后肾损伤的患者感染率明显增加(均P<0.05)。多因素分析结果显示,术后疼痛、术后出血、术后肾损伤、结石残余均为输尿管软镜取石术后发生感染的独立危险因素(均P<0.05)。结论对于行输尿管软镜取石术的输尿管结石患者发生感染的病原菌分布以大肠埃希菌和粪肠球菌为主,其危险因素包含术后疼痛、术后出血、术后肾损伤、结石残余等,应对上述因素给予相应的预防策略以减少感染的发生。
Objective To explore the risk factors and preventive measures of nosocomial infection in patients with ureteral calculi after flexible ureteroscopic lithotripsy.Methods A total of 97 patients with ureteral calculi who suffered from nosocomial infection after flexible ureteroscopic lithotripsy treated in our hospital from May 2015 to May 2017 were selected.Pathogenic bacteria were cultured from patients ' clean urine,and the types and drug resistance rates of pathogens were analyzed,and the risk factors of nosocomial infection were analyzed.Results A total of 141 pathogenic bacteria were detected in 97 patients,of which 96(68.09%) were gram-negative bacteria,28.13% were Escherichia coli,45(31.91%) were Gram-positive bacteria and 42.22% were Enterococcus faecalis.The drug resistance of Escherichia coli to gentamicin was the highest and its sensitivity to imipenem was the highest.Enterococcus faecalis was the most resistant to penicillin and Enterococcus faecalis was the most sensitive to vancomycin and furantoin.Of 97 patients with nosocomial infection,7 had iatrogenic infection,45 had improper wound care,32 had upper genitourinary tract infection and 13 had other causes.The incidence of postoperative bleeding,postoperative pain,residual stones and postoperative renal injury increased significantly(all P < 0.05).Multivariate analysis showed that postoperative pain,postoperative hemorrhage,postoperative renal injury and residual calculi were independent risk factors for renal injury after ureteroscopic lithotripsy(all P < 0.05).Conclusion Escherichia coli and enterococcus faecalis are the main pathogens of infection in patients with ureteral calculi after flexible ureteroscopic lithotripsy.The risk factors include postoperative pain,postoperative hemorrhage,postoperative kidney injury,residual calculi and so on.
Objective To explore the risk factors and preventive measures of nosocomial infection in patients with ureteral calculi after flexible ureteroscopic lithotripsy.Methods A total of 97 patients with ureteral calculi who suffered from nosocomial infection after flexible ureteroscopic lithotripsy treated in our hospital from May 2015 to May 2017 were selected.Pathogenic bacteria were cultured from patients ' clean urine,and the types and drug resistance rates of pathogens were analyzed,and the risk factors of nosocomial infection were analyzed.Results A total of 141 pathogenic bacteria were detected in 97 patients,of which 96(68.09%) were gram-negative bacteria,28.13% were Escherichia coli,45(31.91%) were Gram-positive bacteria and 42.22% were Enterococcus faecalis.The drug resistance of Escherichia coli to gentamicin was the highest and its sensitivity to imipenem was the highest.Enterococcus faecalis was the most resistant to penicillin and Enterococcus faecalis was the most sensitive to vancomycin and furantoin.Of 97 patients with nosocomial infection,7 had iatrogenic infection,45 had improper wound care,32 had upper genitourinary tract infection and 13 had other causes.The incidence of postoperative bleeding,postoperative pain,residual stones and postoperative renal injury increased significantly(all P < 0.05).Multivariate analysis showed that postoperative pain,postoperative hemorrhage,postoperative renal injury and residual calculi were independent risk factors for renal injury after ureteroscopic lithotripsy(all P < 0.05).Conclusion Escherichia coli and enterococcus faecalis are the main pathogens of infection in patients with ureteral calculi after flexible ureteroscopic lithotripsy.The risk factors include postoperative pain,postoperative hemorrhage,postoperative kidney injury,residual calculi and so on.
引文
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[4]王智宇,杨锦建,魏金星,等.输尿管软镜与体外冲击波碎石治疗肾下盏结石术后尿路感染发生的对比分析[J].现代泌尿外科杂志,2016,21(7):529-532.
[5]廖国栋,俞蔚文,章越龙,等.超微经皮肾镜和输尿管软镜在治疗肾结石中的感染控制及疗效的对比研究[J].中华医院感染学杂志,2017,27(11):2543-2546.
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[8]李天,孙祥宙,盛明,等.输尿管软镜负压鞘在输尿管软镜治疗感染性肾结石术中的应用[J].实用医学杂志,2018,34(1):79-82.
[9]GHOSH A,SOMANI B K.Safety and feasibility of day case ureteroscopy and laser lithotripsy(URSL)in patients with a solitary kidney[J].Cent European J Urol,2016,69(1):91-95.
[10]YOUSSEF R F,NEISIUS A,GOLDSMITH Z G,et al.Re:Clinical outcomes after ureteroscopic lithotripsy in patients who initially presented with urosepsis:Matched pair comparison with elective ureteroscopy[J].J Endourol,2014,28(12):1439-1443.
[11]刘万樟,方立.经尿道逆行性输尿管软镜钬激光碎石术后并发感染早期诊治进展[J].国际泌尿系统杂志,2017,37(6):922-926.
[12]ALEZRA E,LASSELIN J,FORZINI T,et al.Prognostic factors for severe infection after flexible ureteroscopy:Clinical interest of urine culture the day before surgery[J].Prog Urol,2016,26(1):65-71.
[13]汪巧萍,蔡珺,沈海萍,等.手术室老年患者输尿管软镜碎石术后感染的预防措施[J].中华医院感染学杂志,2014,24(4):979-980.
[14]周庆,谢波,王荣江,等.感染可能性评分对输尿管软镜术后尿脓毒症的早期预测价值[J].中华现代护理杂志,2017,23(1):83-86.
[15]王凯,王广健.单通道微创经皮肾镜联合输尿管软镜同期、分期治疗复杂性肾结石的临床研究[J].中国医疗设备,2016,31(11):110-112.
[16]伍宏亮.输尿管镜钬激光碎石术后尿源性脓毒血症的危险因素分析[J].中华全科医学,2016,14(12):2031-2033.
[2]VOLKIN D,SHAH O.Complications of ureteroscopy for stone disease[J].Minerva Urol Nefrol,2016,68(6):570-585.
[3]杨文增,崔振宇,安丰,等.输尿管软镜与微通道经皮肾镜在输尿管上段结石治疗中的对比研究[J].中国内镜杂志,2016,22(11):11-14.
[4]王智宇,杨锦建,魏金星,等.输尿管软镜与体外冲击波碎石治疗肾下盏结石术后尿路感染发生的对比分析[J].现代泌尿外科杂志,2016,21(7):529-532.
[5]廖国栋,俞蔚文,章越龙,等.超微经皮肾镜和输尿管软镜在治疗肾结石中的感染控制及疗效的对比研究[J].中华医院感染学杂志,2017,27(11):2543-2546.
[6]达骏,徐明曦,王忠,等.输尿管软镜积极治疗2 cm以下肾结石伴复杂尿路感染[J].现代泌尿外科杂志,2015,20(2):128-130.
[7]徐明曦,达骏,张明,等.输尿管软镜钬激光碎石治疗感染性肾结石的疗效分析[C]//上海市激光学会2015年学术年会论文集.2015:72.
[8]李天,孙祥宙,盛明,等.输尿管软镜负压鞘在输尿管软镜治疗感染性肾结石术中的应用[J].实用医学杂志,2018,34(1):79-82.
[9]GHOSH A,SOMANI B K.Safety and feasibility of day case ureteroscopy and laser lithotripsy(URSL)in patients with a solitary kidney[J].Cent European J Urol,2016,69(1):91-95.
[10]YOUSSEF R F,NEISIUS A,GOLDSMITH Z G,et al.Re:Clinical outcomes after ureteroscopic lithotripsy in patients who initially presented with urosepsis:Matched pair comparison with elective ureteroscopy[J].J Endourol,2014,28(12):1439-1443.
[11]刘万樟,方立.经尿道逆行性输尿管软镜钬激光碎石术后并发感染早期诊治进展[J].国际泌尿系统杂志,2017,37(6):922-926.
[12]ALEZRA E,LASSELIN J,FORZINI T,et al.Prognostic factors for severe infection after flexible ureteroscopy:Clinical interest of urine culture the day before surgery[J].Prog Urol,2016,26(1):65-71.
[13]汪巧萍,蔡珺,沈海萍,等.手术室老年患者输尿管软镜碎石术后感染的预防措施[J].中华医院感染学杂志,2014,24(4):979-980.
[14]周庆,谢波,王荣江,等.感染可能性评分对输尿管软镜术后尿脓毒症的早期预测价值[J].中华现代护理杂志,2017,23(1):83-86.
[15]王凯,王广健.单通道微创经皮肾镜联合输尿管软镜同期、分期治疗复杂性肾结石的临床研究[J].中国医疗设备,2016,31(11):110-112.
[16]伍宏亮.输尿管镜钬激光碎石术后尿源性脓毒血症的危险因素分析[J].中华全科医学,2016,14(12):2031-2033.
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