直肠癌术后导尿管相关尿路感染病原学及影响因素
Etiological characteristics and influencing factors for postoperative urinary catheter-associated urinary tract infection in rectal cancer patients
段娜 1郑玲 1刘战涛 1唐玉洁 2叶霖3
作者信息
- 1. 湖北文理学院附属医院襄阳市中心医院肿瘤科,湖北襄阳 441000
- 2. 湖北文理学院附属医院襄阳市中心医院药学部,湖北襄阳 441000
- 3. 华中科技大学同济医学院附属协和医院普外科,湖北武汉 430000
- 折叠
摘要
目的 分析直肠癌术后导尿管相关尿路感染(CAUTI)病原菌分布、耐药性及其影响因素.方法 选取2021年6月-2022年6月于襄阳市中心医院进行直肠癌根治术的186例患者为研究对象,根据患者术后是否出现CAUTI分为感染组38例和非感染组148例,收集患者中段尿标本进行病原菌培养、鉴定及药敏试验,多因素Logistic回归分析直肠癌患者术后CAUTI的影响因素.结果 多因素Logistic回归分析结果显示,合并基础疾病、留置导尿管时间、术前合并泌尿系统疾病均是直肠癌患者术后发生CAUTI的影响因素(P＜0.05);38例感染患者中共检出56株病原菌,其中革兰阴性菌24株,革兰阳性菌14株,真菌18株;耐药性分析结果表明大肠埃希菌对头孢呋辛、亚胺培南、美罗培南、哌拉西林等的耐药性较低,鲍氏不动杆菌对哌拉西林、阿米卡星的耐药性较低;粪肠球菌对青霉素、左氧氟沙星、替加环素、氨苄西林的耐药性较低,屎肠球菌对庆大霉素、替加环素的耐药性较低;白假丝酵母和光滑假丝酵母对伏立康唑、两性霉素B、5-氟胞嘧啶、氟康唑等的耐药性均较低.结论 直肠癌患者术后发生CAUTI与合并基础疾病、留置导尿管时间、术前合并泌尿系统疾病等有关,感染的主要病原菌为革兰阴性菌,不同病原菌耐药性有差异.
Abstract
OBJECTIVE To observe the distribution and drug resistance of pathogens isolated from the rectal cancer patients with postoperative urinary catheter-associated urinary tract infection(CAUTI)and analyze the influencing factors.METHODS Totally 186 patients with rectal cancer who underwent radical resection in Xiangyang City Hospital from Jun 2021 to Jun 2022 were recruited as the research subjects and were divided into the infection group with 38 cases and the non-infection group with 148 cases according to the status of postoperative CAUTI.The midstream urine specimens were collected from the patients for culture of pathogens,the isolated pathogens were identified,and the drug susceptibility testing was carried out.Multivariate logistic regression analysis was performed for the influencing factors for the postoperative CAUTI.RESULTS The result of the multivariate logis-tic regression analysis showed that complication with underlying diseases,duration of urinary catheter indwelling and complication with urinary system diseases before the surgery were the influencing factors for the postoperative CAUTI in the rectal cancer patients(P＜0.05).Totally 56 strains of pathogens were isolated from the 38 patients with the infection,24 of which were gram-negative bacteria,14 were gram-positive bacteria,and 18 were fungi.The re-sult of the drug susceptibility testing indicated that the drug resistance rates of Escherichia coli strains to cefuroxime,imipenem,meropenem and piperacillin were low;the drug resistance rates of Acinetobacter baumannii strains to pip-eracillin and amikacin were low;the drug resistance rates of the Enterococcus faecalis to penicillin,levofloxacin,tigecy-cline and amikacin were low;the drug resistance rates of the Enterococcus faecium strains to gentamycin and tigecycline were low;the drug resistance rates of Candida albicans and Candida glabrata strains to voriconazole,amphotericin B,5-fluorocytosine and fluconazole were low.CONCLUSION The occurrence of postoperative CAUTI in the rectal cancer pa-tients is associated with the complication with underlying diseases,duration of urinary catheter indwelling and complica-tion with urinary system diseases before surgery.The gram-negative bacteria are dominant among the pathogens causing the infection.There is difference in the drug resistance among the pathogens.
关键词
直肠癌/尿路导管感染/影响因素/病原菌分布/耐药性Key words
Rectal cancer/Catheter-associated urinary tract infection/Influencing factor/Distribution of patho-gen/Drug resistance引用本文复制引用
基金项目
湖北省自然科学基金(2019CFB684)
出版年
2024
NETL
NSTL
维普
万方数据