术前尿培养及细菌种类对上尿路结石患者输尿管软镜碎石术后泌尿生殖系统感染的影响
Influence of preoperative urine culture and bacterial species on urogenital sepsis after ureteral flexible lithotripsy in patients with upper urinary tract stones.
作者信息
Wang Leibo, Yu Xianzhe, Qiu Zuze, Liu Puyu, Tian Wu, He Wei, Pan Yulin, Xu Feng, Cen Zhuangding, Ou Yang, Li Daobing
机构信息
Department of Surgery, Beijing Jishuitan Hospital Guizhou Hospital, Guiyang, China.
Department of Urology, Affiliated Hospital of Zunyi Medical University, Zunyi, China.
出版信息
Front Med (Lausanne). 2024 May 3;11:1393734. doi: 10.3389/fmed.2024.1393734. eCollection 2024.
OBJECTIVE
This retrospective study aims to identify risk factors for urogenic sepsis in patients with upper urinary tract stones following ureteral flexible lithotripsy (FURL). Additionally, we analyze the clinical characteristics of bacterial infections post-surgery.
METHODS
A total of 759 patients who underwent FURL at the Urology Department of Zunyi Medical University were included. Univariate and multivariate Logistic regression analyses were conducted to identify independent risk factors for urogenic sepsis post-FURL. The distribution of bacteria based on preoperative urine cultures was also analyzed. Statistical analysis was performed using R4.2.2 software.
RESULTS
Of the 759 patients, positive preoperative urine culture, urine nitrite positivity, urine white blood cell count (WBC) ≥ 200 cells/μL, residual stones, and neutrophil-to-lymphocyte ratio (NLR) were found to be independent risk factors for urogenic sepsis after FURL. Among the 164 patients with positive preoperative urine cultures, 32 developed urogenic sepsis post-surgery, with 68.75% having positive preoperative cultures. The leading pathogens causing postoperative urogenic sepsis were (), , , and . The probabilities of progression to urogenic sepsis were as follows: 19% ( = 12), 43% ( = 3), 33.3% ( = 1), and 33.3% ( = 1). The ages of affected patients were 47.17 ± 13.2, 53.7, 41, and 79 years, respectively. Rates of comorbid diabetes were 36.4, 66.7, 50, 100%, with nitrite positivity rates at 72.7, 33.3, 50, 0%. Ten female patients were infected with , while patients infected with had an NLR of 7.62.
CONCLUSION
Positive preoperative urine culture, urine nitrite positivity, urine WBC ≥ 200 cells/μL, residual stones, and NLR are independent risk factors for urogenic sepsis after FURL. is the predominant pathogen post-FURL, with notable female prevalence and nitrite-positive urine in infections. infections are associated with diabetes.
目的
本回顾性研究旨在确定输尿管软镜碎石术（FURL）后上尿路结石患者发生尿源性脓毒症的危险因素。此外，我们分析术后细菌感染的临床特征。
方法
纳入遵义医科大学泌尿外科行FURL的759例患者。进行单因素和多因素Logistic回归分析，以确定FURL后尿源性脓毒症的独立危险因素。还分析了基于术前尿培养的细菌分布情况。使用R4.2.2软件进行统计分析。
结果
在759例患者中，术前尿培养阳性、尿亚硝酸盐阳性、尿白细胞计数（WBC）≥200个/μL、残留结石及中性粒细胞与淋巴细胞比值（NLR）被发现是FURL后尿源性脓毒症的独立危险因素。在164例术前尿培养阳性的患者中，32例术后发生尿源性脓毒症，其中68.75%术前培养阳性。导致术后尿源性脓毒症的主要病原体为（）、、、和。进展为尿源性脓毒症的概率如下：19%（=12）、43%（=3）、33.3%（=1）和33.3%（=1）。受影响患者的年龄分别为47.17±13.2岁、53.7岁、41岁和79岁。合并糖尿病的比例分别为36.4%、66.7%、50%、100%，亚硝酸盐阳性率分别为72.7%、33.3%、50%、0%。10例女性患者感染，感染的患者NLR为7.62。
结论
术前尿培养阳性、尿亚硝酸盐阳性、尿WBC≥200个/μL、残留结石及NLR是FURL后尿源性脓毒症的独立危险因素。是FURL后主要病原体，感染中女性患病率高且尿亚硝酸盐阳性。感染与糖尿病有关。
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