Cadková I, Doudová L, Michálek J, Huvar I
Gynekologicko-porodnické oddĕlení Nemocnice Milosrdných bratrí, Brno.
Ceska Gynekol. 2008 Jul;73(4):241-7.
This study eims to evaluate risk factors for postsurgical uroinfection (UTI) in gynecology.
Clinical retrospective trial.
Obstetrics and Gynecology Department, Merciful Brothers Hospital, Brno.
All of 290 women who underwent hysterectomy and/or anterior vaginal repair (with or without anti-incontinence operation) in our hospital during the year 2005 were studied. The following data were noted: age, weight, anamnestic UTI, diabetes, other serious morbidity, moving disorders, estrogene deficiency, the type of surgery, the type of catheter and the duration of its indweling, intra/postoperative complications, urologic symptoms and urine analysis including bacteriology on the 6th postoperative day. There were excluded cases with antibiotic therapy (due to non-urological indications) from the study. The risk factors were assessed on the rest of 262 women, in two subgroups according to the catheter type (Foley/minicatheter), as there were remarcable differences in the indwelling time and other characteristics. "Mini-catheter" (a thin transurethral catheter) enables spontaneous voiding as well as measuring the postmiction residuum. It was used in case of anterior vaginal repair or Burch operation and extracted as soon as the voiding function had been restored, mostly on the 2nd-3rd day. The Foley was used in the others, mostly for one day. The unidimensional (Fisher and Mann-Whitney test) and multidimensional (logit model, Walds statistic) analyses were performed. The influence of the type of catheter itself was analysed within an indwelling time period (20-32 hours) in which women of both subgroups were present.
The Foley group (115 women, indwelling time 16-32 hours) had 3.5% UTI, none of studied factors was estimated as significant. In the mini-catheter group (147 women, catheterisation for 20-234 hours) was 35.4% UTI, with two risk factors: the time of catheterisation (p = 0.000029) and complications (p = 0.021515). The statistic model we have used (logit analysis) predicts UTI with sensitivity 61.5 and specificity 89.5. There was no difference in the risk of UTI between the two types of used catheters in case of equal time of their insertion.
Postsurgical UTI was connected significantly with the duration of catheterisation and intra/postoperative complications. In case of short time catheterisation (up to 32 hours), however, the percentage of UTI was low and no risk factor was assessed as significant.
本研究旨在评估妇科手术后尿路感染（UTI）的危险因素。
临床回顾性试验。
布尔诺仁慈兄弟医院妇产科。
对2005年在我院接受子宫切除术和/或阴道前壁修补术（有无抗尿失禁手术）的290名女性进行了研究。记录了以下数据：年龄、体重、既往UTI病史、糖尿病、其他严重疾病、活动障碍、雌激素缺乏、手术类型、导管类型及其留置时间、术中/术后并发症、泌尿系统症状以及术后第6天的尿液分析（包括细菌学检查）。研究排除了因非泌尿系统指征接受抗生素治疗的病例。根据导管类型（Foley导尿管/迷你导尿管）将其余262名女性分为两个亚组，评估危险因素，因为两者在留置时间和其他特征上存在显著差异。“迷你导尿管”（一种细的经尿道导管）可实现自主排尿并测量排尿后残余尿量。它用于阴道前壁修补术或Burch手术，一旦排尿功能恢复即拔除，大多在第2 - 3天。其他患者使用Foley导尿管，大多使用一天。进行了单因素分析（Fisher检验和Mann - Whitney检验）和多因素分析（logit模型、Wald统计量）。在两个亚组女性均存在的留置时间段（20 - 32小时）内分析了导管类型本身的影响。
Foley导尿管组（115名女性，留置时间16 - 32小时）的UTI发生率为3.5%，未发现所研究的因素具有显著性。迷你导尿管组（147名女性，导尿20 - 234小时）的UTI发生率为35.4%，有两个危险因素：导尿时间（p = 0.000029）和并发症（p = 0.021515）。我们使用的统计模型（logit分析）预测UTI的敏感性为61.5，特异性为89.5。在插入时间相同的情况下，两种使用的导管类型之间UTI风险无差异。
术后UTI与导尿持续时间和术中/术后并发症显著相关。然而，在短时间导尿（长达32小时）的情况下，UTI发生率较低，且未发现危险因素具有显著性。
