膀胱根治性切除术后尿路感染的病原菌分布及耐药分析  

Distribution and drug resistance analysis of pathogenic bacteria in urinary tract infections after radical cystectomy

作　　者：侯轩 张微 赵大委 辜依海 Hou Xuan;Zhang Wei;Zhao Dawei;Gu Yihai(Department of Microbial Immunology,3201 Hospital,Hanzhong,723000,China;Department of Urology,3201 Hospital,Hanzhong,723000,China)

机构地区：[1]三二〇一医院微生物免疫科,汉中723000 [2]三二〇一医院泌尿外科,汉中723000

出　　处：《国际泌尿系统杂志》2025年第1期99-103,共5页International Journal of Urology and Nephrology

基　　金：科技基础资源调查专项项目(SQ2019FY010016)。

摘　　要：目的探讨膀胱根治性切除术后尿路感染的病原菌分布情况,并分析其耐药率。方法回顾性分析2019年8月至2022年9月在本院行膀胱根治性切除术治疗的146例膀胱肿瘤患者的临床资料,根据术后是否出现尿路感染分为感染组(36例)和未感染组(110例),分析尿路感染病原菌的分布情况及耐药率,对比两组患者的临床资料,分析影响膀胱肿瘤患者术后尿路感染的独立危险因素。结果大肠埃希菌对甲氧苄啶、氨苄西林等耐药性较高;铜绿假单胞菌对氨苄西林耐药性较高;肺炎克雷伯菌对甲氧苄啶、四环素等耐药性较高;三者均对亚胺培南敏感。粪肠球菌对四环素、克林霉素耐药性较高;屎肠球菌对青霉素G、左氧氟沙星等耐药性较高;二者均对利奈唑胺、替加环素、万古霉素敏感。单因素及多因素logistic回归分析结果发现住院时间>15 d、术后输尿管导管留置时间>7 d、高血压、抗菌药物使用>3种、白蛋白水平≤40 g/L均是影响膀胱根治性切除术后尿路感染发生的独立危险因素(均P<0.05)。结论革兰阴性菌是导致膀胱根治性切除术后尿路感染的主要致病菌,临床治疗中可给予亚胺培南治疗,减少使用甲氧苄啶、氨苄西林、庆大霉素、四环素、头孢唑林。住院时间>15 d、术后输尿管导管留置时间>7 d、高血压、抗菌药物使用>3种、白蛋白水平≤40 g/L是影响膀胱根治性切除术后尿路感染的独立危险因素,临床需引起重视。Objective To investigate the distribution of pathogenic bacteria in urinary tract infection after radical resection of bladder,and to analyze its drug resistance rate.Methods The clinical data of 146 patients with bladder tumor who underwent radical cystectomy in our hospital from August 2019 to September 2022 were retrospectively analyzed,and they were divided into infected group(36 cases)and uninfected group(110 cases)according to whether urinary tract infection occurred after surgery.The distribution of pathogenic bacteria and drug resistance rate of urinary tract infection were analyzed,and the clinical data of patients in the two groups were compared.The independent risk factors of postoperative urinary tract infection in patients with bladder tumor was analyzed.Results Escherichia coli had high resistance to trimethoprim,ampicillin,Pseudomonas aeraerosa had high resistance to ampicillin,and Klebsiella pneumoniae had high resistance to trimethoprim,tetracycline,all of which were sensitive to imipenem.Enterococcus faecalis had high resistance to tetracycline and clindamycin,while Enterococcus faecium had high resistance to penicillin G,levofloxacin,both of which were sensitive to linezolid,tigacycline and vancomycin.single factor and multivariate logistic regression analysis showed that duration of hospitalization>15 days,postoperative ureteral catheter retention time>7 days,hypertension,antibiotic use>3 kinds,albumin level≤40 g/L were independent risk factors for urinary tract infection after radical cystectomy(all P<0.05).Conclusions Gram-negative bacteria are the main cause of urinary tract infection after radical bladder resection,imipenem can be given,and the use of trimethoprim,ampicillin,gentamicin,tetracycline,cefazolin can be reduced.Duration of hospital stay>15 days,postoperative ureteral catheter retention time>7 days,hypertension,antibiotic use>3 kinds,albumin level≤40 g/L are independent risk factors for urinary tract infection after radical vesical resection,which should be paid attention to

关 键 词：膀胱肿瘤 膀胱切除术 尿路感染 

分 类 号：R44[医药卫生—诊断学]