肾移植术后1年内反复发作性泌尿系感染的危险因素分析  

Risk factors of recurrent urinary tract infection within 1 year after kidney transplantation

作　　者：齐宝玉[1] 李超[1] 钱叶勇[1] 王振[1] 柏宏伟[1] 李钢[1] 范宇[1] 刘路鹏[1] QI Baoyu;LI Chao;QIAN Yeyong;WANG Zhen;BAI Hongwei;LI Gang;FAN Yu;LIU Lupeng(No.2 Department of Urology,Institute of Organ Transplantation of PLA,The 309th Hospital of PLA,Beijing 100091,China)

机构地区：[1]解放军第309医院全军器官移植研究所泌尿二科,北京100091

出　　处：《解放军医学院学报》2018年第8期663-665,669,共4页Academic Journal of Chinese PLA Medical School

摘　　要：目的探讨肾移植术后反复发作性泌尿系感染(recurrent urinary tract infection,RUTI)的高危因素和临床特点。方法回顾性分析本中心259例肾移植受者术后1年内泌尿系感染发生情况,依据发生次数分为单发性感染(isolated urinary tract infection,IUTI)组和RUTI组;分析RUTI的临床特征,应用非条件Logistic回归进行多因素分析,确定其危险因素。结果 RUTI组尿中白细胞数[(2 240±350)/ml vs(123±78)/ml,P<0.01]、并发全身炎症反应比例(68.4%vs 10.5%,P<0.01)、先前应用抗生素比例(89.5%vs 45.3%,P<0.01)、1年移植肾切除率(42.1%vs 0,P<0.01)、受者死亡率(31.6%vs 0,P<0.01)均高于ITUI组。RUTI发生率为7.3%,心脏死亡供肾(HR:2.1,95%CI:1.3~5.6;P<0.01)、多重耐药菌感染(HR:9.2,95%CI:6.1~28.9;P<0.01)是其发生的独立危险因素。结论评估供者来源感染风险、注意多重耐药菌高发性,是防治肾移植术后RUTI的关键。Objective To investigate the risk factors and clinical characteristics of recurrent urinary tract infection（RUTI） after kidney transplantation. Methods The occurrence of UTI in 259 recipients in our transplant-center within 1-year after kidney transplant was retrospectively analyzed. According to the episodes of UTI, the recipients were divided into isolated group and recurrent group. The clinical features of RUTI were analyzed, and the risk factors of RUTI were analyzed using univariate analysis and logistic regression model. Results Recipients in RUTI group had significantly higher mean Leucocyturia number [（2 240±350）/ml vs（123±78）/ml, P 0.01], higher incidence of systemic inflammatory response（68.4% vs 10.5%, P 0.01） and previous using of antibiotics（89.5% vs 45.3%, P 0.01）, higher rate of allograft nephrectomy（42.1% vs 0, P 0.01）, and higher recipient mortality（31.6% vs 0, P 0.01）. The incidence of RUTI was 7.3%, and the independent risk factors of RUTI were donation after circulatory death（HR： 2.2, 95% CI： 1.1-5.2; P 0.01） and multiple drug resistance（HR： 10.2, 95% CI： 5.1-29.6; P 0.01）. Conclusion Accurate evaluation of the risk of donor infection, early detection of MDR is the key to prevent RUTI.

关 键 词：肾移植 泌尿系感染 反复发作性 多重耐药菌 

分 类 号：R699.2[医药卫生—泌尿科学]