颅脑术后患者导尿管相关尿路感染发生情况及其病原学特点  

Occurrence of catheter-related urinary tract infections and their etiologic characteristics in post-cranial surgery patients

作　　者：郭玉 张勇 黄登静 许娇 王英 GUO Yu;ZHANG Yong;HUANG Dengjing;XU Jiao;WANG Ying(School of Nursery University of South China,Hengyang,Hunan 421001,China;Infection Management Office,Sichuan Cancer Hospital,Chengdu,Sichuan 610041,China;Department of Neurosurgery,Army Specialized Medical Center,PLA Army Medical University,Chongqing 400042,China)

机构地区：[1]南华大学护理学院,湖南衡阳421001 [2]四川省肿瘤医院感染管理办公室,四川成都610041 [3]中国人民解放军陆军军医大学陆军特色医学中心神经外科,重庆400042

出　　处：《检验医学与临床》2023年第10期1388-1391,1395,共5页Laboratory Medicine and Clinic

摘　　要：目的探讨颅脑术后患者导尿管相关尿路感染发生率及其病原学特点,分析其危险因素,以预防和减少导尿管发生尿路感染的发生。方法分析2021年4-6月在中国人民解放军陆军军医大学陆军特色医学中心神经外科住院的386例颅脑术后留置导尿管患者的临床资料,调查其尿路感染发生率;观察发生导尿管相关尿路感染患者的尿液病原菌分布情况;对可能与导尿管相关尿路感染有关的因素进行单因素分析,再将差异有统计学意义的因素进行多因素Logistic回归分析。结果386例留置导尿管的颅脑术后患者发生导尿管相关尿路感染25例,发生率为6.48%。共分离病原菌25株,以大肠埃希菌为主(52.0%)。感染者与非感染者在性别、入院方式、格拉斯哥昏迷指数(GCS)评分、留置导尿管时间、合并基础疾病、气管插管、胃肠减压、病危、使用抗凝药物、使用镇静药物及插管环境方面比较,差异均有统计学意义(P<0.05)。GCS评分<7分、气管插管、插管环境为非手术室和留置导尿管时间>7 d是颅脑术后发生导管相关尿路感染的危险因素(P<0.05)。结论引发颅脑术后导尿管相关尿路感染的病原菌以大肠埃希菌为主。较低GCS评分与气管插管的患者更容易发生导尿管相关尿路感染,而改善插管环境、减少留置导尿管的时间可降低导尿管相关尿路感染的发生率。Objective To investigate the incidence of catheter-related urinary tract infections in post-cranial patients and their pathogenic characteristics,and to analyze their associated risk factors in order to prevent and reduce the occurrence of catheter-related urinary tract infections.Methods The clinical data of 386 patients with postoperative indwelling catheterization who were hospitalized in the Department of Neurosurgery in Army Specialized Medical Center,PLA Army Medical University from April to June 2021 were analyzed to investigate the incidence of urinary tract infections,to observe the distribution of urine pathogen detection in patients with catheter-related urinary tract infections,to conduct an univariate analysis of relevant factors that might relate to catheter-related urinary tract infections,and then Logistic regression analysis was carried out for the factors with statistically significant differences.Results A total of 25 catheter-related urinary tract infections occurred in 386 post-cranial surgery patients with indwelling catheters,with an infection rate of 6.48%.There were 25 pathogenic strains isolated,with Escherichia coli predominating(52.0%).There were statistically significant differences on terms of gender,admission mode,Glasgow Coma Scale(GCS)score,indignant catheter time,underlying diseases,tracheal intubation,gastrointestinal decompression,critical illness,use of anticoagulants,use of sedatives and intubation environment between the infected patients and the non-infected patients(P<0.05).GCS score<7 points,tracheal intubation,intubation environment outside the operating room and indwelling catheter time>7 days were the risk factors for catheter-related urinary tract infection during indwelling catheter after cranial surgery(P<0.05).Conclusion Escherichia coli is the predominant pathogen causing catheter-related urinary tract infections in post-cranio surgery patients.Patients with lower GCS score and tracheal intubation are more likely to develop catheter-related urinary tract infection

关 键 词：颅脑术后 导尿管相关尿路感染 病原学特点 

分 类 号：R446.5[医药卫生—诊断学]