经输尿管软镜取石术后院内感染的病原学特征及危险因素探讨

目的探讨分析输尿管结石患者经输尿管软镜取石术后发生院内感染的病原学特征及危险因素。方法选择2016年4月至2018年12月期间本院收治的输尿管结石患者80例患者术后均发生医院感染。培养所有患者的病原菌,分析病原菌的耐药率及院内感染的危险因素,并提出预防措施。结果80例患者共培养出116株病原菌,包含79株革兰阴性菌(68.10%),主要为大肠埃希菌18.97%(22/116)],37株革兰阳性菌(31.90%),主要为粪肠球菌13.79%(16/116)]。大肠埃希菌所对应耐药率最高的药物为庆大霉素,敏感性较高的药物为亚胺培南;粪肠球菌所对应耐药率最高的药物为青霉素,敏感性较高的药物为万古霉素以及呋喃妥因。院内感染诱因包括伤口护理不当、泌尿生殖道上行感染、医源性感染等多因素logistic回归分析显示,术后肾损伤、结石残余、术后疼痛、术后出血等均为引发术后院内感染的独立危险因素。结论输尿管结石患者接受输尿管软镜取石术治疗后,发生院内感染的主要病原菌为粪肠球菌、大肠埃希菌,由术后肾损伤、结石残余、术后疼痛、术后出血等危险因素引发,需针对以上危险因素给予相应干预措施,达到降低术后院内感染的目的。

Pathogenic characteristics and risk factors of nosocomial infection after flexible ureteroscopic lithotripsy

Objective To explore the risk factors and preventive measures of nosocomial infection in patients with ureteral calculi after flexible ureteroscopic lithotripsy.Methods From April 2016 to December 2018,80 patients with ureteral calculi were selected.Nosocomial infection occurred in all patients after operation.The pathogenic bacteria were cultured,the drug resistance rate of pathogenic bacteria and the risk factors of nosocomial infection were analyzed,and the preventive measures were put forward.Results A total of 116 pathogenic bacteria were cultured from 80 patients,including 79 gram-negative hacteria(68.10%),mainly escherichia coli(18.97%),37 gram-positive bacteria(31.90%)and enterococcus faecalis(13.79%).Gentamycin was the drug with the highest drug resistance rate in escherichia coli,imipenem was the drug with higher sensitivity,penicillin was the drug with the highest drug resistance rate in enterococcus faecalis,vancomycin and furantoin were the drug with higher sensitivity.The causes of nosocomial infection include improper wound care,urinary and reproductive tract infection,iatrogenic infection,etc.Multivariate logistic regression analysis showed that post-operative renal injury,residual stones,post-operative pain and post-operative bleeding were risk factors for nosocomial infection.Conclusions Enterococcus faecalis and escherichia coli are the main pathogens of nosocomial inlection in patients with ureteral calculi after flexible ureteroscopic lithotripsy.They are caused by residual calculi,renal injury,post-operative bleeding,post-operative pain and other risk factors.Corresponding intervention measures should he taken to reduce these risk lactors.