膀胱癌术后膀胱灌注治疗过程中尿路感染的危险因素、流行特征分析及预测模型构建  

Analysis of risk factors and epidemic characteristics and prediction model construction of urinary tract infection during bladder perfusion therapy after bladder cancer surgery

作　　者：姚彬彬 郑文文 徐影 YAO Binbin;ZHENG Wenwen;XU Ying(Department of Infection Management,Second Affiliated Hospital of Shanghai University,Theorem Clinical College,Wenzhou Medical University,Wenzhou Central Hospital,Wenzhou 325000,China)

机构地区：[1]上海大学附属第二医院/温州医科大学定理临床学院/温州市中心医院感染管理科,浙江温州325000

出　　处：《空军军医大学学报》2024年第11期1308-1313,共6页Journal of Air Force Medical University

基　　金：浙江省医药卫生科技计划项目(2023XY137)。

摘　　要：目的探讨膀胱癌术后膀胱灌注化疗人群疗程中尿路感染流行特征及影响因素。方法选取2021年1月至2023年12月在温州市中心医院治疗的膀胱癌术后膀胱灌注化疗患者100例,观察患者尿路感染发生情况,分析发生和未发生尿路感染患者临床资料差异,以及尿路感染的影响因素。结果有32例患者确诊为尿路感染,感染率为32.00%。共检出病原菌40株,革兰阴性菌和革兰阳性菌分别占67.50%和32.50%;革兰阴性菌中,以大肠埃希菌和肺炎克雷伯菌为主,革兰阳性菌中以肠球菌属为主。大肠埃希菌对头孢呋辛、头孢曲松和左旋氧氟沙星耐药性高,肺炎克雷伯菌对阿米卡星、替加环素耐药率为0.00%,肠球菌属对红霉素、四环素耐药性较高;发生尿路感染患者年龄≥60岁、糖尿病史、留置导尿管、手术时间≥90 min、灌注化疗次数>5次、白蛋白水平<35 g/L比例分别为59.37%、37.50%、40.63%、59.37%、46.87%和56.25%,明显高于未发生尿路感染患者(P<0.05)。logistic回归显示:年龄、糖尿病、留置导尿管、灌注化疗次数、白蛋白是发生尿路感染的影响因素(P<0.01)。构建尿路感染的列线图模型,其ROC曲线下面积为0.801(95%CI:0.711~0.892),敏感度和特异度分别为75.00%和80.90%。结论膀胱癌术后膀胱灌注化疗患者尿路感染发生率较高,以大肠埃希菌、肺炎克雷伯菌感染为主;尿路感染发生受患者年龄、糖尿病等多种因素的影响。Objective To investigate the epidemic characteristics and influencing factors of urinary tract infection during the course of intravesical chemotherapy after bladder cancer surgery.Methods From January 2021 to December 2023,100 patients with bladder cancer treated with postoperative bladder perfusion chemotherapy in Wenzhou Central Hospital were selected to observe the incidence of urinary tract infection,and analyze the differences in clinical data between patients with and without urinary tract infection,as well as the influencing factors of urinary tract infection.Results A total of 32 patients were diagnosed with urinary tract infections,with an infection rate of 32.00%.A total of 40 strains of pathogenic bacteria were detected,with Gram-negative and Gram-positive bacteria accounting for 67.50%and 32.50%,respectively.The Gram-negative bacteria were mainly Escherichia coli and Klebsiella pneumoniae,while the Gram-positive bacteria were mainly Enterococcus.Escherichia coli had high resistance to cefuroxime,ceftriaxone,and levofloxacin,Klebsiella pneumoniae had a resistance rate of 0.00%to amikacin and tigecycline,and Enterococcus had high resistance to erythromycin and tetracycline.The proportions of patients with urinary tract infection in clinical data such as age≥60 years,history of diabetes,indwelling urinary catheter,operation time≥90 min,times of infusion chemotherapy>5,albumin level<35 g/L were 59.37%,37.50%,40.63%,59.37%,46.87%and 56.25%,respectively,which were significantly higher than those without urinary tract infection(P<0.05).Logistic regression analysis showed that age,diabetes,indwelling urinary catheter,times of infusion chemotherapy and albumin were the influencing factors of urinary tract infection(P<0.01).A nomogram model for urinary tract infection was constructed,and the area under the ROC curve was 0.801(95%CI:0.7110.892),with a sensitivity of 75.00%and specificity of 80.90%.Conclusion The incidence of urinary tract infection is high in patients with bladder cancer who received intrav

关 键 词：膀胱癌 膀胱灌注化疗 尿路感染 流行特征 影响因素 

分 类 号：R737.14[医药卫生—肿瘤]