产超广谱β-内酰胺酶尿路病原菌引起的医院获得性尿路感染：患病率、病原菌、危险因素及感染控制策略
Nosocomial urinary tract infections caused by extended-spectrum beta-lactamase uropathogens: Prevalence, pathogens, risk factors, and strategies for infection control.
作者信息
Bouassida Khaireddine, Jaidane Mehdi, Bouallegue Olfa, Tlili Ghassen, Naija Habiba, Mosbah Ali Tahar
机构信息
Department of Urology, Hospital of Sahloul, Sousse, Tunisia;
Department of Microbiology, Hospital of Sahloul, Sousse, Tunisia.
出版信息
Can Urol Assoc J. 2016 Mar-Apr;10(3-4):E87-93. doi: 10.5489/cuaj.3223.
INTRODUCTION
Our goal was to investigate the prevalence and antibiogram pattern of extended spectrum beta-lactamase (ESBL) production among uropathogens using isolates from urine samples collected at the Department of Urology in the Sahloul Hospital, Tunisia We also aimed to identify the risk factors for nosocomial urinary tract infections (UTIs) in patients who underwent transurethral resection of the prostate (TURP) and the measures for infection control.
METHODS
Laboratory records of a five-year period from January 2004 to December 2008 were submitted for retrospective analysis to determine the incidence of ESBL infections. A total of 276 isolates were collected. A case-control study involving comparisons between two groups of patients who underwent TURP was performed to determine the risk factors for ESBL infection. Group 1, designated case subjects, included 51 patients with nosocomial UTI after TURP. Group 2, designated control subjects, consisted of 58 randomly selected patients who underwent TURP without nosocomial UTI in the same period. Factors suspected to be implicated in the emergence of ESBL infection were compared between the two groups in order to identify risk factors for infection. A univariate regression analysis was performed, followed by a multivariate one.
RESULTS
The annual prevalence of ESBL infection ranged from 1.3-2.5%. After performing univariate and multivariate regression analysis, the main risk factors for ESBL infections were identified as: use of antibiotics the year preceding the admission, duration of catheter use, and bladder washout (p=0.012, p=0.019, and p<0.001.
CONCLUSIONS
Urologists have to perform a good hemostasis, especially in endoscopic resections, in order to avoid bladder irrigation and bladder washout and to reduce the time of bladder catheterization, which is a strong risk factor of nosocomial UTIs.
引言
我们的目标是利用突尼斯萨赫勒医院泌尿外科收集的尿液样本分离株，调查尿路病原体中产超广谱β-内酰胺酶（ESBL）的流行情况和抗菌谱模式。我们还旨在确定接受经尿道前列腺切除术（TURP）的患者发生医院获得性尿路感染（UTI）的危险因素以及感染控制措施。
方法
提交了2004年1月至2008年12月这五年期间的实验室记录进行回顾性分析，以确定ESBL感染的发生率。共收集了276株分离株。进行了一项病例对照研究，比较两组接受TURP的患者，以确定ESBL感染的危险因素。第1组为病例组，包括51例TURP术后发生医院获得性UTI的患者。第2组为对照组，由同期随机选择的58例接受TURP且未发生医院获得性UTI的患者组成。比较两组之间怀疑与ESBL感染出现有关的因素，以确定感染的危险因素。先进行单变量回归分析，然后进行多变量回归分析。
结果
ESBL感染的年患病率在1.3%-2.5%之间。在进行单变量和多变量回归分析后，确定ESBL感染的主要危险因素为：入院前一年使用抗生素、导尿管使用时间和膀胱冲洗（p=0.012、p=0.019和p<0.001）。
结论
泌尿外科医生必须做好止血工作，尤其是在内镜切除术中，以避免膀胱冲洗和膀胱灌洗，并减少膀胱插管时间，因为这是医院获得性UTIs的一个重要危险因素。
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