泌尿系术后发生真菌感染的特点及危险因素分析

摘要/Abstract

摘要： 目的探讨泌尿系术后发生真菌感染的特点及危险因素,为临床提供依据。方法回顾性分析2017年6月—2021年5月在我院接受泌尿系统手术治疗的762例泌尿系统疾病患者的临床资料,根据其术后是否发生泌尿系、血液真菌感染,分为感染组(n=75)及非感染组(n=687)。比较两组患者临床资料,并进行单因素分析与Logistic回归分析。结果 762例患者中75例发生术后真菌感染,发生率为9.84%,其中患者疾病类型以泌尿系结石为主,病原菌以念珠菌为主,导管留置以DJ管、导尿管为主;在75例泌尿系术后发生真菌感染中,69例无症状,5例尿频、尿急、尿痛,1例畏寒、发热、腰痛。单因素分析结果显示,感染组年龄>65岁、开放手术、手术时间≥30 min、引流管留置时间>7 d、抗菌药物使用时间≥3 d所占比例较非感染组更高(P<0.05),血糖水平、CRP水平高于非感染组(P<0.05);Logistic多因素分析结果显示,年龄(OR=1.604)、手术方式(OR=1.139)、导管留置时间(OR=2.537)、血糖水平(OR=2.753)、抗菌药物使用时间(OR=2.508)、CRP(OR=3.057)是影响泌尿系术后发生真菌感染的独立危险因素(P<0.05)。结论泌尿系术后真菌感染的常见病原菌为念珠菌且多无临床症状,常见疾病为泌尿系结石,常见导管留置为DJ管、导尿管。年龄>65岁、开放手术、导管留置时间>7 d、血糖水平升高、抗菌药物使用超过3 d、CRP升高是影响术后泌尿系发生真菌感染的独立危险因素,需进行针对性干预。

关键词: 泌尿系, 真菌感染, 危险因素

Abstract: Objective To investigate the characteristics and risk factors of postoperative fungal infection in urinary system. Methods The clinical data of 762 patients with urinary system diseases who underwent urological surgery in our hospital from June 2017 to may 2021 were retrospectively analyzed. According to whether they had urinary system and blood fungal infection after operation, they were divided into infection group (n=75) and non infection group (n=687). The clinical data of the two groups were compared, and univariate analysis and logistic regression analysis were performed. Results 75 of the 762 patients had postoperative fungal infection, the incidence was 9.84%. The main disease type was urinary calculi, the main pathogen was Candida, and the main indwelling catheters were DJ tube and catheter; Among 75 cases of fungal infection after urinary system operation, 69 cases were asymptomatic, 5 cases had frequent urination, urgency and pain, and 1 case had chills, fever and low back pain. The results of univariate analysis showed that the proportion of age >65 years, open operation, operation time ≥ 30 min, drainage tube retention time >7 d, antibacterial drug use time ≥ 3 d in the infection group was higher than that in the non infection group (P<0.05), and the blood glucose level and CRP level in the infection group were higher than those in the non infection group (P<0.05); Logistic multivariate analysis showed that age (OR=1.604), operation method (OR=1.139), catheter retention time (OR=2.537), blood glucose level (OR=2.753), antibacterial drug use time (OR=2.508) and CRP (OR=3.057) were independent risk factors for fungal infection after urinary surgery (P<0.05). Conclusion The common pathogen of postoperative fungal infection in urinary system was Candida and most of them had no clinical symptoms. The common disease was urinary calculi. The common catheters indwelling were DJ tube and catheter. Age >65 years old, open surgery, catheter retention time >7 d, elevated blood glucose level, more than 3 d use of antibiotics, and elevated CRP were independent risk factors for postoperative urinary fungal infection, which need targeted intervention.

Key words: urinary system, mycotic infection, risk factors

中图分类号:

R519

严秋, 刘红. 泌尿系术后发生真菌感染的特点及危险因素分析[J]. 中国真菌学杂志, 2023, 18(1): 8-11,18.

YAN Qiu, LIU Hong. Characteristics and risk factors of fungal infection after urinary surgery[J]. Chinese Journal of Mycology, 2023, 18(1): 8-11,18.

参考文献

[1] 何磊.老年泌尿道感染患者病原菌分布特点及耐药状况[J].中国现代医生,2022,60(1):144-147.
[2] 叶俊兵,叶利洪,何建松,等.尿石症患者并发真菌感染的菌群分布、药敏及危险因素分析[J].中国真菌学杂志,2021,16(6):384-387,402.
[3] 马炎,王婷,孙志萍,等.微创手术治疗子宫肌瘤后发生泌尿系统感染患者病原菌分布和炎症细胞因子水平变化情况[J].中国妇幼保健,2021,36(22):5156-5159.
[4] 刘锦,邵国杰,周鑫,等.G试验联合尿真菌培养对泌尿系侵袭性真菌感染诊断效能的影响[J].武警医学,2021,32(11):921-924.
[5] 朱磊,陈菁菁,高念吉.94例糖尿病肾病患者并发泌尿系感染的病原菌分布及其耐药性分析[J].抗感染药学,2021,18(9):1306-1309.
[6] 张烁,孙立颖,熊辉.急诊留置尿管患者泌尿系病原菌分布及耐药性分析[J].中国临床药理学杂志,2021,37(15):2051-2055.
[7] 张钻兵,李美珍,邱琳.某院2018年-2019年泌尿系结石患者尿路感染病原菌的分布及其耐药性分析[J].抗感染药学,2021,18(7):1018-1021.
[8] 周航,吴石萍,谢明,等.350例泌尿系结石患者尿路感染相关病原菌的分布特征与耐药性分析[J].抗感染药学,2021,18(5):644-647.
[9] 姜燕燕,褚云卓.老年患者泌尿系统感染病原菌构成与耐药情况分析[J].中国医科大学学报,2021, 50(5):444-448. [10] 龚丽英. 肾移植术后感染病原体分布、多重耐药菌耐药特点及危险因素分析[D].济南:山东大学,2021. [11] 刘秀英,安新业.老年患者导尿管相关念珠菌泌尿系感染菌株分布及药敏分析[J].甘肃医药,2021, 40(5):433-435. [12] European Association for the Study of the liver.EASL Clinical Practice Guidelines:Drug-induced liver injury[J].J Hepatol,2019,70(6):1222-1261. [13] BLAUWKAMP T A,THAIR S,ROSEN M J,et al.Analytical and clinical validation of a microbial cell-free DNA sequencing test for infectious disease[J].Nat Microbiol,2019,4(4):663-674. [14] LIMPER A H,ADENIS A,LE T,et al.Fungal infections in HIV/AIDS[J].Lancet Infect Dis,2017,17(11):e334-343. [15] LANGELIER C,KALANTAR K L,MOAZED F,et al.Integrating host response and unbiased microbe detection for lower respiratory tract infection diagnosis in critically ill adults[J].Proc Natl Acad Sci U S A,2018,115(52):E12353-E12362. [16] 徐宏业,张玲玲,杜国强,等.腹腔镜肾盂成形术后双J管相关泌尿系统感染的危险因素分析[J].临床小儿外科杂志,2021,20(4):334-339.