膀胱癌术后合并尿路感染者病原学分布、炎症因子及免疫功能分析
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摘要
目的探讨膀胱癌术后合并尿路感染者病原学分布及其对炎症因子水平及免疫功能的影响。方法选择海南省第三人民医院2016年3月～2017年9月泌尿外科82例膀胱癌术后合并尿路感染患者作为观察组,选择膀胱癌术后未感染者42例为对照组,检测两组患者红细胞免疫功能及炎症因子的水平并进行比较分析;取尿液进行病原菌培养及药敏试验,分析尿路感染相关影响因素。结果 NTER、ATER、ETER及DTER观察组患者分别为(1.35±0.21)%、(51.46±5.61)%、(32.29±3.34)%、(29.37±3.27)%,对照组分别为(2.26±0.35)%、(63.11±6.42)%、(46.24±5.13)%、(38.66±3.99)%,差异均有统计学意义(P<0.05);IL-1β、IL-6、PGE2及TNF-α对照组分别为(2.67±0.38) pg/ml、(7.69±0.74)pg/ml、(141.23±14.55) pg/ml、(1.19±0.14) ng/ml,对照组分别为(1.25±0.27) pg/ml、(2.95±0.31) pg/ml、(105.29±11.02) pg/ml、(0.81±0.09) ng/ml,差异均有统计学意义(P<0.05)。82例患者中段尿共分离培养出94株病原菌,其中革兰阴性菌占74.47%,以大肠埃希菌(占24.47%)、肺炎克雷伯菌(占14.89%)和阴沟肠杆菌(占13.83%)居多;革兰阳性菌占25.53%,以尿肠球菌(占9.57%)、链球菌属(占7.45%)为主。大肠埃希菌、肺炎克雷伯菌及阴沟肠杆菌对美罗培南、亚胺培南及阿米卡星敏感性较高(耐药率为0～7.69%),而对氨苄西林和氟喹诺酮类药物耐药性较高(耐药率为46.15%～100.00%)。其中尿肠球菌、链球菌属及金葡萄球菌属尿肠球菌、链球菌属及金葡萄球菌属呋喃妥因、万古霉素敏感(耐药率为0-11.11%),对红霉素、青霉素、环丙沙星耐药性较高(耐药率为50.00%～100.00%)。多元Logistic回归分析显示,年龄≥65岁、手术时间长(>90 min)、糖尿病及术前因尿潴留行导尿术均是膀胱癌术后尿路感染的独立危险因素(P<0.05)。结论膀胱癌术后感染者免疫功能较低,体内存在微炎症。感染病原菌以革兰阴性菌为主,年龄≥65岁、手术时间长(>90 min)、患糖尿病及术前因尿潴留行导尿术为尿路感染独立危险因素,因此应采取相应预防措施以减少膀胱癌术后尿路感染的发生。
Objectives To investigate the pathogen distribution, inflammatory factors, and immune function of patients with a urinary tract infection after surgery for bladder cancer. Methods Clinical data on 82 patients with a urinary tract infection after urinary surgery from March 2016 to September 2017 were collected. These patients served as the observation group. Forty-two patients with bladder cancer without an infection served as the control group. RBC counts, immune function, and levels of inflammatory factors were compared between the two groups. Urine was taken for pathogen culture and drug susceptibility testing, and relevant factors influencing the development of an infection were analyzed. Results The levels of NTER, ATER, ETER, and DTER in the observation group were significantly lower than those in the control group, and the levels of IL-1β, IL-6, PGE2, and TNF-α were significantly higher than those in the control group(P<0.05). A total of 94 pathogens were isolated from mid-stream urine samples from 82 patients. Most of the strains(74.47%) were Gram-negative bacteria. The most prevalent Gram-negative bacteria were Escherichia coli(24.47%), Klebsiella pneumoniae(14.89%), and Enterobacter cloacae(13.83%). Gram-positive bacteria accounted for 25.53% of the isolated strains; most were Enterococcus faecium(9.57%) and Streptococcus(7.45%). E. coli, K. pneumoniae, and E. cloacae are more sensitive to meropenem, imipenem and amikacin but more resistant to ampicillin and fluoroquinolones. E. faecium, Streptococcus, Staphylococcus aureus, Enterococcus, Staphylococcus and S. aureus were sensitive to nitrofurantoin and vancomycin(resistance: 0-11.11%) but highly resistant to erythromycin, penicillin, and ciprofloxacin(resistance: 50.00% to 100.00%). Multiple logistic regression analysis indicated that being over the age of 65, a long operating time, having diabetes, and preoperative catheterization due to urinary retention were independent risk factors for infection in patients with bladder cancer. Conclusion Patients with bladder cancer have lower immune function after infection and microinflammation. The pathogens causing a urinary tract infection were mainly Gram-negative bacteria, and more attention should be paid to patients to over the age of 65, those with a long operating time, those with diabetes, and those undergoing preoperative catheterization due to urinary retention in order to reduce the rate of infection.
Objectives To investigate the pathogen distribution, inflammatory factors, and immune function of patients with a urinary tract infection after surgery for bladder cancer. Methods Clinical data on 82 patients with a urinary tract infection after urinary surgery from March 2016 to September 2017 were collected. These patients served as the observation group. Forty-two patients with bladder cancer without an infection served as the control group. RBC counts, immune function, and levels of inflammatory factors were compared between the two groups. Urine was taken for pathogen culture and drug susceptibility testing, and relevant factors influencing the development of an infection were analyzed. Results The levels of NTER, ATER, ETER, and DTER in the observation group were significantly lower than those in the control group, and the levels of IL-1β, IL-6, PGE2, and TNF-α were significantly higher than those in the control group(P<0.05). A total of 94 pathogens were isolated from mid-stream urine samples from 82 patients. Most of the strains(74.47%) were Gram-negative bacteria. The most prevalent Gram-negative bacteria were Escherichia coli(24.47%), Klebsiella pneumoniae(14.89%), and Enterobacter cloacae(13.83%). Gram-positive bacteria accounted for 25.53% of the isolated strains; most were Enterococcus faecium(9.57%) and Streptococcus(7.45%). E. coli, K. pneumoniae, and E. cloacae are more sensitive to meropenem, imipenem and amikacin but more resistant to ampicillin and fluoroquinolones. E. faecium, Streptococcus, Staphylococcus aureus, Enterococcus, Staphylococcus and S. aureus were sensitive to nitrofurantoin and vancomycin(resistance: 0-11.11%) but highly resistant to erythromycin, penicillin, and ciprofloxacin(resistance: 50.00% to 100.00%). Multiple logistic regression analysis indicated that being over the age of 65, a long operating time, having diabetes, and preoperative catheterization due to urinary retention were independent risk factors for infection in patients with bladder cancer. Conclusion Patients with bladder cancer have lower immune function after infection and microinflammation. The pathogens causing a urinary tract infection were mainly Gram-negative bacteria, and more attention should be paid to patients to over the age of 65, those with a long operating time, those with diabetes, and those undergoing preoperative catheterization due to urinary retention in order to reduce the rate of infection.
引文
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[8] 范祎,杜军,於裕福.膀胱肿瘤经尿道电切术后尿路感染病原菌分析[J].中华医院感染学杂志,2014,24(11):2773-5.
[9] 朱明挺,贾晶蓉,王国录,等.膀胱镜检查后患者尿路感染病原菌分布与耐药性分析[J].中华医院感染学杂志,2016,26(15):3489-91.
[10] 牛俊豪,王俊勇,张莹,等.110例泌尿外科危重症患者尿路感染病原学及耐药性分析[J].中华医院感染学杂志,2017,27(9):2054-6.
[11] 王于良,汪超军,张孝旭,等.经尿道膀胱肿瘤切除术后尿路感染病原学分析[J].中华医院感染学杂志,2014,24(11):2642-4.
[12] 张欣.全国14家医院2014-2016年临床上抗菌药物使用情况分析[J].中国现代应用药学,2017,34(9):1334-8.
[13] 高凤蕊,金婷婷,刘伟.浅表性膀胱癌患者术后医院感染影响因素分析[J].中华医院感染学杂志,2014,24(09):2249-50,2253.
[14] 黄翔,蔡海荣,施思.膀胱癌老年患者发生医院感染的病原菌种类及危险因素分析[J].中华医院感染学杂志,2017,27(9):2057-9.
[15] 李朋,张伟丽,尤升杰,等.泌尿外科患者尿路感染危险因素分析与临床预防研究[J].中华医院感染学杂志,2015,5(7):1626-8.
[2] 兰海河,张战宏,胡新红.经尿道膀胱肿瘤电切术后三种化疗方案治疗浅表性膀胱癌的疗效及安全性比较[J].实用癌症杂志,2016,31(12):2044-6.
[3] Gondo T,Ohno Y,Nakashima J,et al.Factors predicting incisional surgical site infection in patients undergoing open radical cystectomy for bladder cancer.[J].Int J Clin Oncol,2014,19(5):935-9.
[4] 范展,刘秋霞,张海霞,等.手术切口感染患者血清及创口分泌物炎症介质的变化研究[J].中华医院感染学杂志,2016,26(13):2997-8,3007.
[5] 中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):460-5.
[6] Calvert JK,Holt SK,Mossanen M,et al.Use and outcomes of extended antibiotic prophylaxis in urological cancer surgery[J].J Urol,2014,192(2):425-9.
[7] 操作亮,刘双林,袁劲东,等.膀胱癌患者术后尿路感染免疫状态与炎症介质[J].中华医院感染学杂志,2018,28(11):1697-700.
[8] 范祎,杜军,於裕福.膀胱肿瘤经尿道电切术后尿路感染病原菌分析[J].中华医院感染学杂志,2014,24(11):2773-5.
[9] 朱明挺,贾晶蓉,王国录,等.膀胱镜检查后患者尿路感染病原菌分布与耐药性分析[J].中华医院感染学杂志,2016,26(15):3489-91.
[10] 牛俊豪,王俊勇,张莹,等.110例泌尿外科危重症患者尿路感染病原学及耐药性分析[J].中华医院感染学杂志,2017,27(9):2054-6.
[11] 王于良,汪超军,张孝旭,等.经尿道膀胱肿瘤切除术后尿路感染病原学分析[J].中华医院感染学杂志,2014,24(11):2642-4.
[12] 张欣.全国14家医院2014-2016年临床上抗菌药物使用情况分析[J].中国现代应用药学,2017,34(9):1334-8.
[13] 高凤蕊,金婷婷,刘伟.浅表性膀胱癌患者术后医院感染影响因素分析[J].中华医院感染学杂志,2014,24(09):2249-50,2253.
[14] 黄翔,蔡海荣,施思.膀胱癌老年患者发生医院感染的病原菌种类及危险因素分析[J].中华医院感染学杂志,2017,27(9):2057-9.
[15] 李朋,张伟丽,尤升杰,等.泌尿外科患者尿路感染危险因素分析与临床预防研究[J].中华医院感染学杂志,2015,5(7):1626-8.