结石细菌培养在控制逆行软性输尿管镜激光碎石术后感染性并发症中的作用  

The Effect of Bacterial Culture for Stone on the Treatment of Post-Surgical Infection Complication After Flexible Ureteroscopic Lithotomy

作　　者：张燚 马路平[1] 王勤章[1] 王少刚[3] 刘继红[3] 李强[1] 曾凯 Zhang Yi;Ma Luping;Wang Qinzhang(Department of Urology,the First Affiliated Hospital,Shihezi University,Shihezi 832003,China;Medical College,Shihezi University,Shihezi 832003,China)

机构地区：[1]石河子大学第一附属医院泌尿外科,石河子832003 [2]石河子大学医学院,石河子832003 [3]华中科技大学同济医学院附属同济医院泌尿外科,武汉430030

出　　处：《华中科技大学学报（医学版）》2024年第5期653-658,共6页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：国家自然科学基金资助项目(No.82360606);新疆生产建设兵团科技计划项目(No.2021AB032)。

摘　　要：目的评估术前中段尿、肾盂尿及结石细菌培养在控制逆行软性输尿管镜激光碎石术(FURL)后感染性并发症中的作用及价值。方法回顾性收集2021年11月至2023年5月在石河子大学第一附属医院和华中科技大学同济医学院附属同济医院行FURL的326例肾结石患者的临床资料,收集患者术前中段尿、术中肾盂尿及结石标本进行细菌培养。根据术后感染发生情况将患者分为非感染组和感染组,记录患者围手术期细菌培养及药物敏感性试验结果、感染指标及抗生素使用等情况,分析患者发生感染性并发症的相关危险因素。结果326例患者术后有38例(11.66%)发生了全身炎症反应综合征(SIRS),15例(4.60%)发展为严重脓毒血症。术前中段尿、肾盂尿及结石细菌培养的阳性率分别为16.87%(55/326)、10.43%(34/326)和15.95%(52/326)。单因素及多因素Logistic回归分析显示结石大小(P=0.010)、手术时间(P=0.030)和结石细菌培养(P<0.01)是术后发生SIRS的独立危险因素。结石细菌培养阳性是术后发生严重脓毒血症的独立危险因素(P=0.047)。大肠埃希菌是3种标本中检出阳性率最高的细菌,结石来源大肠埃希菌对氨基糖苷类及β内酰胺酶类抗生素耐药比例较高。结论结石细菌培养阳性是FURL术后发生感染性并发症的独立危险因素,结石细菌培养有助于指导FURL术后抗菌药物的使用,建议针对FURL术后感染高危人群进行结石细菌培养及药敏试验。Objective To assess the risk factors for systemic inflammatory response syndrome(SIRS)induced by flexible ureteroscopic lithotripsy(FURL)and compare the diagnostic value of bacterial culture for stone,midstream urine culture and pelvic urine culture in predicting postoperative infection.Methods Patients who underwent FURL for upper urinary tract stones from November 2021 to May 2023 were retrospectively enrolled.The patients were divided into non-SIRS and SIRS groups.We collected midstream urine one day before surgery and stone and pelvic urine samples during surgery.Multivariate logistic regression analysis was used to identify the risk factors for SIRS induced by FURL.Results Totally,326 patients,11.66%(38/326)developed SIRS,and 4.29%(14/326)had severe sepsis.The percentages of positive bacterial cultures for midstream urine,pelvic urine and stone cultures were 16.87%(55/326),10.43%(34/326)and 15.95%(52/326),respectively.In the multivariate logistic regression analysis,stone size(P=0.010),operation time(P=0.030),and stone culture(P<0.01)were identified as independent risk factors for SIRS induced by FURL.Positive bacterial culture for stone was an independent risk factor for postoperative severe sepsis(P=0.047).E.coli was the most common pathogen cultured from the three samples.Compared with midstream urine and pelvic urine,a greater proportion of E.coli in stone were resistant to aminoglycoside andβ-lactamase antibiotics.Conclusion Positive bacterial culture for stone was associated with an increased incidence of postoperative SIRS.Bacterial culture for stone might have important clinical value in the treatment of postoperative infection in FURL patients.

关 键 词：肾结石 结石细菌培养 全身炎症反应综合征 软性输尿管镜 并发症 

分 类 号：R699[医药卫生—泌尿科学]