髋关节置换术后留置尿管患者尿路感染真菌分布,耐药性及易感因素分析  

Analysis of fungal distribution,drug resistance,and susceptibility factors for urinary tract infections in patients with indwelling catheterization after hip replacement surgery

作　　者：王春霞 毕龙 牛志霞 WANG Chunxia;BI Long;NIU Zhixia(Department of Orthopaedics,The First Affiliated Hospital of Air Force Military Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学第一附属医院骨科二病区,西安710032

出　　处：《中国真菌学杂志》2024年第5期465-472,479,共9页Chinese Journal of Mycology

基　　金：军事训练伤防治研究任务项目(20XLS13)。

摘　　要：目的探究髋关节置换术(hip arthroplasty,HA)患者术后留置尿管发生尿路真菌感染的病原菌分布特征、耐药性及易感因素。方法纳入空军军医大学第一附属医院骨科二病区2019年1月—2023年12月收治的1923例HA术后留置尿管患者,根据是否发生尿路真菌感染分为实验组(感染)134例,对照组(未感染)1789例。临床分离非重复真菌菌株,分析HA术后留置尿管发生尿路真菌感染的菌群分布特征;并进行药敏试验,归纳术后留置尿管患者尿路真菌敏感率(S)和耐药率(R)情况;收集临床资料,进行单因素及多因素logistic回归分析,经回归方程拟合的概率值构建风险预测模型。结果134例发生尿路真菌感染的患者中,共收集非重复真菌菌株148株,主要为白念珠菌,占比43.24%(64/148);其次是热带念珠菌,占比22.97%(34/148)。药敏结果显示,除克柔念珠菌对氟康唑天然耐药外,所有真菌对三种唑类抗真菌药物表示不同敏感率,其中伊曲康唑的耐药率最高,敏感性明显低于氟康唑、伏立康唑(P<0.05)。除2种主要检出真菌对5-氟胞嘧啶、两性霉素B保持高敏感率(S>90%),其他真菌对5-氟胞嘧啶、两性霉素B完全敏感(S=100%);所有真菌对卡泊芬净完全敏感(S=100%)。logistic回归分析显示:年龄、留置尿管时间、留置尿管次数、C反应蛋白、降钙素原、(1,3)-β-D葡聚糖、合并糖尿病、抗菌药物使用时间、抗菌药物使用史是HA术后留置尿管致使尿路真菌感染的独立危险因素(P<0.05);ROC分析显示:年龄、留置尿管时间、留置尿管次数、C反应蛋白、降钙素原、(1,3)-β-D葡聚糖、抗菌药物使用时间及联合预测术后真菌感染方面均具有统计学意义(P<0.05);糖尿病、抗菌药物使用史预测术后真菌感染方面均不具有统计学意义(P>0.05)。结论HA术后留置尿管发生尿路真菌感染以白念珠菌为主,年龄、留置尿管时间、留置尿管次数、C反应蛋白、降钙�Objective To investigate the distribution characteristics,drug resistance,and susceptibility factors of urinary tract fungi infections caused by indwelling catheterization in patients undergoing hiparthroplasty(HA).Methods A total of 1923 patients with indwelling urinary catheters after HA surgery admitted to the Orthopedics Department ward 2 of the First Affiliated Hospital of the Air Force Medical University from January 2019 to December 2023 were divided into an experimental group(infected)of 134 cases and a control group(uninfected)of 1789 cases based on whether urinary tract fungi infections occurred.Clinical isolation of non repetitive fungal strains and analysis of the distribution characteristics of urinary tract fungal infections caused by indwelling catheterization after HA surgery;And conduct drug sensitivity tests to summarize the urinary tract fungal sensitivity rate(S)and drug resistance rate(R)of patients with postoperative indwelling catheterization;Collect clinical data,conduct univariate and multivariate logistic regression analysis,and construct a risk prediction model based on the probability values fitted by the regression equation.Results Among 134 patients with urinary tract fungal infections,a total of 148 non repetitive fungal strains were collected,mainly Candida albicans,accounting for 43.24%(64/148);next was Candida tropicalis,accounting for 22.97%(34/148).The drug sensitivity results showed that,except for Candida krusei,which was naturally resistant to fluconazole,all fungi showed different sensitivity rates to the three azoles.Among them,itraconazole had the highest resistance rate and was significantly less sensitive than fluconazole and voriconazole(P<0.05).Except for the two main detected fungi that maintained high sensitivity to 5-fluorocytosine and amphotericin B(S>90%),other fungi were completely sensitive to 5-fluorocytosine and amphotericin B(S=100%);All fungi are completely sensitive to caspofungin(S=100%).Logistic regression analysis showed that age,indwelling catheter tim

关 键 词：髋关节置换术 留置尿管 真菌感染 耐药性 易感因素 

分 类 号：R519[医药卫生—内科学] R691.3[医药卫生—临床医学]