尿道狭窄患者的耻骨上膀胱造瘘管相关性尿路感染的危险因素  

Risk factors of suprapubic catheter-associated infection in patients with urethral stricture

作　　者：林家豪 苑炜 梁涛[1] 戴正皓 谷遇伯 王平 宋鲁杰[1] LIN Jiahao;YUAN Wei;LIANG Tao;DAI Zhenghao;GU Yubo;WANG Ping;SONG Lujie(Department of Urology,Shanghai Jiao Tong University Affiliated Sixth People s Hospital,Shanghai Eastern Institute of Urologic Reconstruction,Shanghai 200233;Shanghai Electric Power Hospital,Shanghai 200052,China)

机构地区：[1]上海交通大学附属第六人民医院泌尿外科,上海东方泌尿修复重建研究所,上海200233 [2]上海电力医院泌尿外科,上海200052

出　　处：《现代泌尿外科杂志》2022年第6期483-488,共6页Journal of Modern Urology

摘　　要：目的分析尿道狭窄患者的耻骨上膀胱造瘘管相关性尿路感染的发生率和危险因素,并通过细菌学检测确定其病原菌谱。方法收集2020年12月-2021年2月于上海交大第六人民医院院就诊的留置膀胱造瘘管的85例尿道狭窄患者117根膀胱造瘘管的临床资料和实验室检查结果,采用单因素和多因素分析确定导管相关性感染的危险因素。结果导管相关性菌尿(CAB)的发生率为39.3%,最常见的病原菌是大肠埃希菌(30.4%)、肺炎克雷伯菌(13.0%);其中,导管相关性尿路感染(CAUTI)的发生率为23.1%,最常见的病原菌是大肠埃希菌(33.3%)、粪肠球菌(14.8%)。造瘘管培养的阳性率为89.7%,最常见的病原菌是大肠埃希菌(18.1%)、粪肠球菌(13.3%)。单因素分析显示总造瘘持续时间、单根造瘘管留置时间、造瘘管材质、使用抗生素情况和造瘘管培养结果与CAB的发生有关(P<0.05);总造瘘持续时间、造瘘管培养结果与CAUTI的发生有关(P<0.05)。多因素分析结果显示单根造瘘管留置时间(OR=1.054,95%CI:1.022~1.088,P=0.001)是CAB的独立危险因素;总造瘘持续时间(OR=1.007,95%CI:1.002~1.011,P=0.002)和单根造瘘管留置时间(OR=1.0035,95%CI:1.005~1.065,P=0.021)是CAUTI的独立危险因素。结论单根造瘘管留置时间是CAB和CAUTI共同的独立危险因素,而总造瘘持续时间延长可能与患者出现CAUTI相关。CAB和CAUTI的常见病原菌以革兰氏阴性菌为主,造瘘管培养的细菌谱中革兰阴性菌和革兰氏阳性菌比例相近。Objective To investigate the incidence and risk factors of catheter-associated urinary tract infection(CAUTI)in patients with urethral stricture who had suprapubic catheter indwelled,and to determine the pathogen spectrum.Methods The clinical and laboratory data of patients with urethral stricture with suprapubic catheter treated during Dec.2020 and Feb.2021 were retrospectively analyzed.The risk factors of CAUTI were identified with univariate and multivariate analyses.The pathogen spectrum was determined with urine culture and catheter culture.Results A total of 117 suprapubic catheters from 85 patients were collected.The incidence of catheter-associated bacteriuria(CAB)was 39.3%,and the most common pathogens were Escherichia coli(30.4%)and Klebsiella pneumoniae(13.0%).The incidence of CAUTI was 23.1%,and the most frequent pathogens were Escherichia coli(33.3%)and Enterococcus faecalis(14.8%).The positive rate of suprapubic catheter culture was 89.7%,and the most common pathogens were Escherichia coli(18.1%)and Enterococcus faecalis(13.3%).Univariate analysis suggested that the total indwelling time of suprapubic catheter,indwelling time of single suprapubic catheter,type of suprapubic catheter,antibiotics use and culture result of suprapubic catheter were significant predictors of CAB(P<0.05),while the total indwelling time of suprapubic catheter and culture result of suprapubic catheter were risk factors of CAUTI(P<0.05).Multivariate analysis revealed that indwelling time of single suprapubic catheter(OR=1.054,95%CI:1.022~1.088,P=0.001)was an independent risk factor of CAB,while prolonged total indwelling time of suprapubic catheter(OR=1.007,95%CI:1.002~1.011,P=0.002)and prolonged indwelling time of single suprapubic catheter(OR=1.0035,95%CI:1.005~1.065,P=0.021)were related to CAUTI.Conclusion The indwelling time of single suprapubic catheter is an independent risk factor of CAB and CAUTI,and prolonged total indwelling time of suprapubic catheter is associated with the occurrence of CAUTI.Gram-negative bacter

关 键 词：耻骨上膀胱造瘘 导管相关性尿路感染 导管相关性菌尿 尿培养 病原菌 

分 类 号：R639[医药卫生—外科学]