摘要
目的探讨泌尿外科经尿道手术术后医院获得性尿路感染(hospital acquired urinary tract infection,HAUTI)病原菌中产超广谱β-内酰胺酶(extended spectrum beta-lactamase,ESBL)菌的分布情况及危险因素。方法回顾性分析2017年1月至2019年1月在首都医科大学电力教学医院泌尿外科住院期间发生HAUTI感染的460例患者的临床资料,根据ESBL检出情况将患者分为ESBL菌感染组(141例)和非ESBL菌感染组(319例)。分析患者的病原菌分布情况,不同手术类型患者的产ESBL菌感染情况以及产ESBL菌感染的危险因素。结果251例患者接受经尿道输尿管镜下钬激光碎石术,产ESBL菌感染率为27.9%(70/251);128例接受经尿道前列腺等离子电切术,产ESBL菌感染率为22.7%(29/128);81例接受经尿道膀胱肿瘤等离子电切术,产ESBL菌感染率为51.9%(42/81)。在本研究中,HAUTI感染患者共检出10种病原菌。产ESBL菌141例(30.7%),其中产ESBL的大肠埃希菌占比26.3%,产ESBL的肺炎克雷伯菌占比4.3%。多因素logistic分析结果显示,手术时间长、过去1年的尿路感染史和导尿管留置时间>4d是患者产ESBL菌感染的独立危险因素。结论经尿道膀胱肿瘤等离子电切术患者术后的产ESBL菌感染率较高,且手术时间长、过去1年的尿路感染史和导尿管留置时间长是经尿道手术患者术后产ESBL菌感染的独立危险因素。
Objective To investigate the distribution and risk factors of extended spectrum beta-lactamase(ESBL)infection in pathogens of hospital acquired urinary tract infection(HAUTI)after urological surgery.Method Clinical data of 460 patients with HAUTI during hospitalization in the Department of Urology,Electric Power Teaching Hospital of Capital Medical University from January 2017 to January 2019 were retrospectively analyzed.They were divided into ESBL infection group(141 cases)and non-ESBL infection group(319 cases).The distribution of pathogenic bacteria in patients,ESBL infection in patients with different surgical types and risk factors of ESBL infection were analyzed.Result ESBL infection rate of transurethral holmium laser lithotripsy was 27.9%(70/251).The infection rate of ESBL was 22.7%(29/128)in patients undergoing transurethral plasma resection of prostate.The infection rate of ESBL was 51.9%(42/81)in patients undergoing plasma resection of transurethral bladder tumor.A total of 10 pathogens were detected in HAUTI patients.The composition ratio of ESBL-producing bacteria was 30.7%with 141 cases,and the composition ratio of ESBL-producing Escherichia coli was 26.3%,and that of ESBL-producing Klebsiella pneumoniae was 4.3%.Multivariate regression analysis showed that long operation time,history of urinary tract infection in the past one year and catheter indwelling time>4d were independent risk factors for ESBL infection.Conclusion The infection rate of ESBL bacteria after transurethral plasma resection of bladder tumor was higher,and long operation time,history of urinary tract infection in the past one year,and long duration of catheter indwelling were independent risk factors for ESBL infection.
作者
石凤华
矫健
郑安
董长连
Shi Fenghua;Jiao Jian;Zheng An;Dong Changlian(Department of Urology,Electric Power Teaching Hospital of Capital Medical University,Beijing 100073,China;Department of Breast,Electric Power Teaching Hospital of Capital Medical University,Beijing 100073,China;Department of Obstetrics and Gynecology,Electric Power Teaching Hospital of Capital Medical University,Beijing 100073,China)
出处
《中国医刊》
CAS
2022年第8期867-870,共4页
Chinese Journal of Medicine
基金
北京市卫生健康科研基金项目(20200152)。
