摘要
目的探究膀胱癌患者经尿道膀胱肿瘤切除(TURBT)术后尿道感染的病原菌特点,分析导致其发生的危险因素并建立预测模型.方法选取河北北方学院附属第一医院2018年3月-2020年3月接受TURBT治疗的535例膀胱癌患者,根据患者尿道感染情况分为感染组(n=117)和未感染组(n=418);分析感染组患者病原菌及耐药性,比较两组患者一般资料、病理特征及手术情况,归纳膀胱癌患者TURBT术后尿道感染的危险因素并构建预测模型,并采用受试者工作特征(ROC)曲线分析预测模型.结果117例膀胱癌术后尿道感染患者共培养分离病原菌134株,其中革兰阴性菌占70.90%,以大肠埃希菌和肺炎克雷伯菌为主;革兰阳性菌占29.10%,以屎肠球菌和链球菌属为主;大肠埃希菌和肺炎克雷伯菌对美罗培南和阿米卡星较敏感,对头孢噻肟、氨苄西林、左氧氟沙星和环丙沙星的耐药率较高;屎肠球菌和链球菌属对呋喃妥因和万古霉素敏感,对环丙沙星、红霉素以及青霉素耐药率较高;糖尿病史、盆腔放疗史、手术时间及导尿管留置时间是膀胱癌患者TURBT术后尿道感染的危险因素(P<0.05),方差膨胀系数(VIF)均<3;膀胱癌患者TURBT术后尿道感染预测模型为Log(P)=-2.334+糖尿病史×1.148+盆腔放疗史×1.528+手术时间×0.749+导尿管留置时间×1.252,其曲线下面积(AUC)为0.693(P<0.05),敏感度为71.79%,特异度为56.70%.结论膀胱癌患者TURBT术后尿道感染病原菌以革兰阴性菌为主,患有糖尿病、既往有盆腔放疗史、手术时间和导尿管留置时间较长均可能增加患者术后尿道感染风险,临床防控相关因素可有效预防患者TURBT术后尿道感染.
OBJECTIVE To investigate the characteristics of pathogenic bacterial of urinary tract infection in bladder cancer patients after transurethral resection of bladder tumor(TURBT),and to analyze the risk factors leading to its occurrence and develop a predictive model.METHODS A total of 535 bladder cancer patients who underwent TURBT in the First Affiliated Hospital of Hebei North University from Mar.2018 to Mar.2020 were selected and divided into infected group(n=117)and uninfected group(n=418)according to the presence or absence of urinary tract infection.The pathogenic bacteria and drug resistance of patients in the infected group were analyzed,the general data,pathological characteristics and surgical conditions of the two groups were compared,risk factors for urinary tract infection in bladder cancer patients after TURBT were summarized,and a prediction model was constructed,and the prediction model was analyzed using the receiver operating characteristic(ROC)curve.RESULTS A total of 134 pathogenic bacteria strains were isolated from 117 patients with urinary tract infection,of which gram-negative bacteria accounted for 70.90%,mainly Escherichia coli and Klebsiella pneumoniae.Grampositive bacteria accounted for 29.10%,mainly Enterococcus faecium and Streptococcus.E.coli and K.pneumoniae were more sensitive to meropenem and amikacin,while highly resistant to cefotaxime,ampicillin,levofloxacin and ciprofloxacin.E.faecium and Streptococcus were more sensitive to nitrofurantoin and vancomycin,while highly resistant to ciprofloxacin,erythromycin and penicillin.History of diabetes mellitus,history of pelvic radiotherapy,duration of surgery and duration of catheter indwelling were independent risk factors for postoperative urinary tract infection in bladder cancer patients(P<0.05),all with variance inflation factor(VIF)<3.The predictive model for urinary tract infection in bladder cancer patients after TURBT was as follows:Log(P)=-2.334+diabetes history X 1.148+pelvic radiotherapy history X1.528+operation timeX 0.749+
作者
王哲
张敬
张潮
刘鑫
张倩倩
陈怀安
苗文隆
WANG Zhe;ZHANG Jing;ZHANG Chao;LIU Xin;ZHANG Qian-qian;CHEN Huai-an;MIAO Wen-long(The First Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei O75000,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2023年第19期2944-2948,共5页
Chinese Journal of Nosocomiology
基金
河北省临床医学优秀人才培养财政厅基金资助项目[冀财社(2017)46号]张家口市重点研发计划基金资助项目(2121071D)。
关键词
膀胱癌
术后尿道感染
病原菌
危险因素
预测模型
经尿道膀胱肿瘤切除
Bladder cancer
Postoperative urinary tract infection
Pathogen
Susceptible factor
Prediction model
Transurethral resection of bladder tumor
