尿道狭窄患者术前菌尿的病原菌分布及危险因素分析

doi:10.19723/j.issn.1671-167X.2023.05.026

摘要/Abstract

关键词: 尿道狭窄, 细菌尿, 术前, 尿细菌培养

中图分类号:

R691.3

刘振华,王建伟,黄广林,李贵忠,满立波. 尿道狭窄患者术前菌尿的病原菌分布及危险因素分析[J]. 北京大学学报（医学版）, 2023, 55(5): 943-947.

振华刘,建伟王,广林黄,贵忠李,立波满. [J]. Journal of Peking University (Health Sciences), 2023, 55(5): 943-947.

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参考文献 17

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3	Barbagli G , Montorsi F , Balo S , et al. Treatments of 1 242 bulbar urethral strictures: Multivariable statistical analysis of results[J]. World J Urol, 2019, 37 (6): 1165- 1171. doi: 10.1007/s00345-018-2481-6
4	Yuan W , Gu Y , Zhang K , et al. Postoperative infection of male posterior urethral stenosis with pelvic fracture: A retrospective study from a Chinese tertiary teferral center[J]. Urology, 2021, 154, 294- 299. doi: 10.1016/j.urology.2021.04.021
5	Bascom A , Ghosh S , Fairey AS , et al. Assessment of wound complications after bulbar urethroplasty: The impact of a lambda perineal incision[J]. Urology, 2016, 90, 184- 188. doi: 10.1016/j.urology.2015.12.047
6	Anger JT , Santucci R , Grossberg AL , et al. The morbidity of urethral stricture disease among male medicare beneficiaries[J]. BMC Urol, 2010, 10, 3. doi: 10.1186/1471-2490-10-3
7	Romero Pérez P , Mira Llinares A . Urinary infection and urethral stenosis in males[J]. Actas Urol Esp, 1990, 14 (6): 401- 406.
8	Noble R , Hoy N , Rourke K . Accurately defining the incidence and associations of 90-day complications after urethroplasty: Adverse impact of patient comorbidities, preoperative bacteriuria and prior urethroplasty[J]. J Urol, 2022, 208 (2): 350- 359. doi: 10.1097/JU.0000000000002688
9	乔庐东, 陈山, 杨勇, 等. 国内不同类型下尿路感染患者尿路病原菌构成及药敏分析的多中心研究[J]. 中华泌尿外科杂志, 2015, 36 (9): 690- 693. doi: 10.3760/cma.j.issn.1000-6702.2015.09.016
10	李贵忠, 满立波, 黄广林. 创伤性尿道狭窄患者感染病原菌分布与药敏分析[J]. 中华医院感染学杂志, 2015, 25 (13): 2959- 2961.
11	李飞, 邓波, 朱世琴, 等. 住院患者导尿管相关尿路感染危险因素的Meta分析[J]. 中国感染控制杂志, 2018, 17 (9): 770- 776. doi: 10.3969/j.issn.1671-9638.2018.09.004
12	McDonald ML , Buckley J . Antimicrobial practice patternsfor urethroplasty: Opportunity for improved stewardship[J]. Urology, 2016, 94, 237- 245. doi: 10.1016/j.urology.2016.03.051
13	Sedor J , Mulholland SG . Hospital-acquired urinary tract infections associated with the indwelling catheter[J]. Urol Clin N Am, 1999, 26 (4): 821- 828. doi: 10.1016/S0094-0143(05)70222-6
14	林家豪, 苑炜, 梁涛, 等. 尿道狭窄患者的耻骨上膀胱造瘘管相关性尿路感染的危险因素[J]. 现代泌尿外科杂志, 2022, 27 (6): 483- 488. doi: 10.3969/j.issn.1009-8291.2022.06.008
15	Bonkat G , Pickard R , Bartoletti R , et al. EAU guidelines on urological infections 2021[M]. Arnhem: European Association of Urology Guidelines Office, 2021: 1- 20.
16	Bonfill X , Rigau D , Esteban-fuertes M , et al. Efficacy and safety of urinary catheters with silver alloy coating in patients with spinal cord injury: A multicentric pragmatic randomized controlled trial[J]. Spine J, 2017, 17 (11): 1650- 1657. doi: 10.1016/j.spinee.2017.05.025
17	Manjunath A , Chen L , Welty LJ , et al. Antibiotic prophylaxis after urethroplasty may offer no benefit[J]. World J Urol, 2020, 38 (5): 1295- 1301. doi: 10.1007/s00345-019-02880-x

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Variables	Value
Age/years, ${\bar x}$ ± s	47.6±16.4
BMI/(kg/m²), ${\bar x}$ ± s	24.4±3.5
Etiology of stricture, n(%)
Traumatic	60 (49.6)
Iatrogenic	18 (14.9)
Inflammatory	35 (28.9)
Idiopathic	8 (6.6)
Location of stricture, n (%)
Anterior urethra	57 (47.1)
Posterior urethra	64 (52.9)
Length of stricture/cm, M (P₂₅, P₇₅)	3.0 (2.0, 5.5)
Time of stricture/month, M (P₂₅, P₇₅)	10 (5, 36)
Diabetes, n (%)
Yes	18 (14.9)
No	103 (85.1)
Indwelling catheter, n (%)
Yes	78 (64.5)
No	43 (35.5)
Urine culture, n (%)
Positive	81 (33.1)
Negative	40 (66.9)
Antibiotics application, n (%)
Unused	51 (42.1)
Time ≤ 7 d	32 (26.5)
Time > 7 d	38 (31.4)

Pathogenic bacteria	Strains, n	Constituent ratio/%
Gram negative bacteria	63	62.4
Escherichia coli	27	26.7
Pseudomonas aeruginosa	7	6.9
Klebsiella pneumoniae	4	3.9
Acinetobacter baumannii	6	5.9
Serratia proteamaculans	2	2.0
Serratia liquefaciens	3	3.0
Serratia marcescens	2	2.0
Klebsiella aerogenes	2	2.0
Proteus mirabilis	2	2.0
Citrobacter freundii	1	1.0
Citrobacter braque	1	1.0
Providencia alcalifaciens	1	1.0
Stenotrophomonas maltophilia	1	1.0
Morganella morganii	1	1.0
Enterobacter aggregates	1	1.0
Aeromonas hydrophila	1	1.0
Corynebacterium striatum	1	1.0
Gram positive bacteria	32	31.7
Staphylococcus epidermidis	14	13.9
Enterococcus faecalis	7	6.9
Staphylococcus haemolyticus	2	2.0
Staphylococcus aureus	2	2.0
Enterococcus faecium	3	3.0
Staphylococcus hominis	2	2.0
Streptococcus agalactiae	1	1.0
Staphylococcus saprophyticus	1	1.0
Fungi	6	5.9
Candida glabrata	3	3.0
Candida parapsilosis	1	1.0
Candida albicans	1	1.0
Candida guilliermondii	1	1.0

Variables	Urine culture		χ²/Z/t	P
Variables	Positive	Negative	χ²/Z/t	P
Age/years, ${\bar x}$ ± s	50.7±15.5	41.4±16.7	3.043	0.003
BMI/(kg/m²), ${\bar x}$ ± s	24.6±3.6	24.0±3.2	0.942	0.348
Etiology of stricture, n (%)			1.497	0.683
Traumatic	41 (68.3)	19 (31.7)
Iatrogenic	10 (55.6)	8 (44.4)
Inflammatory	25 (71.4)	10 (28.6)
Idiopathic	5 (62.5)	3 (37.5)
Location of stricture, n (%)			0.201	0.654
Anterior urethra	37 (64.9)	20 (35.1)
Posterior urethra	44 (68.8)	20 (31.3)
Length of stricture/cm, M (P₂₅, P₇₅)	3.0 (2.0, 8.0)	3.0 (2.5, 4.0)	0.768	0.432
Time of stricture /month, M (P₂₅, P₇₅)	10.0 (4.5, 36.0)	10.0 (5.0, 36.0)	0.000	>0.999
Diabetes, n (%)			4.602	0.032
Yes	16 (88.9)	2 (11.1)
No	65 (63.1)	38 (36.9)
Indwelling catheter, n (%)			15.609	<0.001
Yes	62 (79.5)	16 (20.5)
No	19 (44.2)	24 (55.8)
Antibiotics application, n (%)			2.312	0.315
Unused	38 (25.5)	13 (74.5)
Time ≤ 7 d	20 (62.5)	12 (37.5)
Time > 7 d	23 (60.5)	15 (39.5)

Variables	Bacteriuria		χ²/Z/t	P
Variables	ABU	UTI	χ²/Z/t	P
Age/years, ${\bar x}$ ± s	49.7±15.9	52.9±14.6	0.871	0.386
BMI/(kg/m²), ${\bar x}$ ± s	24.1±3.8	25.6±3.3	1.704	0.092
Etiology of stricture, n (%)			4.034	0.250
Traumatic	30 (73.2)	11 (26.8)
Iatrogenic	8 (80.0)	2 (20.0)
Inflammatory	13 (52.0)	12 (48.0)
Idiopathic	3 (60.0)	2 (40.0)
Location of stricture, n (%)			3.010	0.083
Anterior urethra	21 (56.8)	16 (43.2)
Posterior urethra	33 (75.0)	11 (25.0)
Length of stricture/cm, M (P₂₅, P₇₅)	3.0 (2.0, 6.0)	4.5 (2.0, 10.0)	0.832	0.406
Time of stricture /month, M (P₂₅, P₇₅)	8 (4, 39)	11 (6, 36)	0.653	0.513
Diabetes, n (%)			0.039	0.844
Yes	11 (68.8)	5 (31.3)
No	43 (66.2)	22 (33.8)
Indwelling catheter, n (%)			0.138	0.711
Yes	42 (67.7)	20 (32.3)
No	12 (63.2)	7 (36.8)
Antibiotics application, n (%)			0.500	0.779
Unused	26 (68.4)	12 (31.6)
Time ≤ 7 d	14 (70.0)	6 (30.0)
Time > 7 d	14 (60.9)	9 (39.1)

Variables	OR	95%CI	P
Age	1.026	0.999-1.053	0.057
Diabetes (yes)	2.933	0.582-14.787	0.192
Indwelling catheter (yes)	4.269	1.834-9.935	0.001

尿道狭窄患者术前菌尿的病原菌分布及危险因素分析

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