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肾移植术后尿路感染209例的临床特点及危险因素分析

王培宇, 丁汉东, 钟金彪, 等. 肾移植术后尿路感染209例的临床特点及危险因素分析[J]. 器官移植. doi: 10.3969/j.issn.1674-7445.2024095
引用本文: 王培宇, 丁汉东, 钟金彪, 等. 肾移植术后尿路感染209例的临床特点及危险因素分析[J]. 器官移植. doi: 10.3969/j.issn.1674-7445.2024095
Wang Peiyu, Ding Handong, Zhong Jinbiao, et al. Clinical characteristics and risk factors of 209 cases of urinary tract infection after kidney transplantation[J]. ORGAN TRANSPLANTATION. doi: 10.3969/j.issn.1674-7445.2024095
Citation: Wang Peiyu, Ding Handong, Zhong Jinbiao, et al. Clinical characteristics and risk factors of 209 cases of urinary tract infection after kidney transplantation[J]. ORGAN TRANSPLANTATION. doi: 10.3969/j.issn.1674-7445.2024095

肾移植术后尿路感染209例的临床特点及危险因素分析

doi: 10.3969/j.issn.1674-7445.2024095
基金项目: 国家自然科学基金(82170787);安徽省泌尿外科临床医学研究中心项目(2019)
详细信息
    作者简介:
    通讯作者:

    梁朝朝(ORCID 0000-0003-2317-1323),博士研究生导师,主任医师,研究方向为微创泌尿外科,Email:liang_chaozhao@163.com

  • 中图分类号: R617, R691

Clinical characteristics and risk factors of 209 cases of urinary tract infection after kidney transplantation

More Information
  • 摘要:   目的   探讨肾移植术后不同时期尿路感染的特点及其相关危险因素。  方法  回顾性分析209例肾移植受者的临床资料,按照术后随访时间分为3个时期,第一时期为移植术后1个月内,第二时期为术后1~6个月,第三时期为术后7个月~1年。分析肾移植术后不同时期尿路感染的发生情况,发生尿路感染受者的尿培养结果及常见病原菌耐药特点。分析反复尿路感染者的菌群,分析尿路感染的危险因素及尿路感染对移植肾功能的影响。  结果  第一时期尿路感染率为90.0%,第二时期尿路感染率为49.3%,第三时期尿路感染率为22.5%。第二时期、第三时期亲属活体器官捐献男性受者的尿路感染率低于女性受者(均为P<0.05)。尿培养结果阳性60例,共检出病原菌84株,以革兰阴性菌为主,其中肺炎克雷伯菌占比最高。66例受者反复发生尿路感染,检出病原菌包括肺炎克雷伯菌、大肠埃希菌、光滑假丝酵母菌和其他。单因素分析结果显示,术后使用抗胸腺细胞球蛋白是第一时期发生尿路感染的危险因素,术前尿路感染、供者类型是第二时期发生尿路感染组的危险因素,受者性别、年龄是第三时期发生尿路感染的危险因素;多因素分析结果显示,术后使用抗胸腺细胞球蛋白是第一时期发生尿路感染的危险因素,受者性别、年龄是第三时期发生尿路感染的危险因素(均为P<0.05)。第三时期治愈65例,未治愈38例,后者治疗前后血清肌酐及白细胞水平差异无统计学意义(均为P>0.05)。  结论  肾移植受者尿路感染以革兰阴性菌为主,其耐药性较高;术后使用抗胸腺细胞球蛋白、女性和高龄是肾移植受者发生尿路感染的危险因素。

     

  • 表  1  肾移植术后不同时期尿路感染率

    Table  1.   Urinary tract infection rates at different periods after kidney transplantation

    时期供者类型总体(N=209)男性(n=146)女性(n=63)P
    n感染[n(%)]n感染[n(%)]n感染[n(%)]
    第一时期公民逝世后器官捐献115102(89)7666(87)3936(92)0.572b
    亲属活体器官捐献9486(91)7062(89)2424(100)0.191b
    第二时期公民逝世后器官捐献11549(43)7631(41)3918(46)0.303a
    亲属活体器官捐献9454(57)7036(51)2418(75)0.044a
    第三时期公民逝世后器官捐献11528(24)7615(20)3913(33)0.108a
    亲属活体器官捐献9419(20)7010(14)249(38)0.032b
      注:a为χ2检验,b为连续性修正χ2检验
    下载: 导出CSV

    表  2  第一时期受者发生尿路感染的危险因素分析

    Table  2.   Analysis of risk factors for urinary tract infection in recipients at the first period

    项目 非尿路感染组(n=21) 尿路感染组(n=188) 单因素分析 多因素分析
    χ2/t P OR(95% CI P
    性别[n(%)] 2.788 0.095
     男 18(86) 128(68)
     女 3(14) 60(32)
    年龄($\overline x \pm s $,岁) 34±10 36±10 0.868 0.386
    合并高血压[n(%)] 18(86) 151(80) 0.771
    合并糖尿病[n(%)] 0 2(1) 1.000
    术前血清肌酐($\overline x \pm s $,μmoI/L) 987±278 885±276
    合并术前尿路感染[n(%)] 2(10) 29(15) 0.746
    透析方式[n(%)] 0.113
     血液透析 16(76) 142(76)
     腹膜透析 3(14) 42(22)
    供着类型[n(%)] 0.447 0.504
     公民逝世后器官捐献 13(62) 102(54)
     亲属活体器官捐献 8(38) 86(46)
    术后使用ATG[n(%)] 13(62) 70(37) 4.802 0.028 0.37(0.14~0.93) 0.034
    下载: 导出CSV

    表  3  第二时期受者发生尿路感染的危险因素分析

    Table  3.   Analysis of risk factors for urinary tract infection in recipients at the second period

    项目 非尿路感染组(n=106) 尿路感染组(n=103) 单因素分析 多因素分析
    χ2/t P OR(95% CI P
    性别[n(%)] 2.229 0.135
     男 79(75) 67(65)
     女 27(25) 36(35)
    年龄($\overline x \pm s $,岁) 37±10 36±10 0.456 0.649
    合并高血压[n(%)] 88(83) 81(79) 0.647 0.421
    合并糖尿病[n(%)] 1(1) 1(1) 1.000
    术前血清肌酐($\overline x \pm s $,μmoI/L) 919±275 871±280
    合并术前尿路感染[n(%)] 10(9) 21(20) 4.962 0.026 2.05(0.88~4.75) 0.096
    透析方式[n(%)] 0.115
     血液透析 80(75) 78(76)
     腹膜透析 25(24) 20(19)
    供者类型[n(%)] 4.556 0.033 0.63(0.36~1.13) 0.121
     公民逝世后器官捐献 66(62) 49(48)
     亲属活体器官捐献 40(38) 54(52)
    术后使用ATG[n(%)] 41(39) 42(41) 0.096 0.757
    下载: 导出CSV

    表  4  第三时期患者发生尿路感染的危险因素分析

    Table  4.   Analysis of risk factors for urinary tract infection in recipients at the third period

    项目 非尿路感染组(n=162) 尿路感染组(n=47) 单因素分析 多因素分析
    χ2/t P OR(95% CI P
    性别[n(%)] 7.997 0.005 2.70(1.36~5.36) 0.004
     男 121(75) 25(53)
     女 41(25) 22(47)
    年龄($\overline x \pm s $,岁) 35±10 39±10 2.044 0.042 1.04(1.00~1.07) 0.035
    合并高血压[n(%)] 133(82) 36(77) 0.713 0.398
    合并糖尿病[n(%)] 2(1) 0 1.000
    术前血清肌酐($\overline x \pm s $,μmoI/L) 901±282 874±261
    合并术前尿路感染[n(%)] 21(13) 10(21) 1.993 0.158
    透析方式[n(%)] 1.000
     血液透析 127(78) 31(66)
     腹膜透析 30(19) 15(32)
    供者类型[n(%)] 0.507 0.476
     公民逝世后器官捐献 87(54) 28(60)
     亲属活体器官捐献 75(46) 19(40)
    术后使用ATG[n(%)] 64(40) 19(40) 0.013 0.910
    下载: 导出CSV

    表  5  尿路感染治疗对肾功能影响

    Table  5.   The impact of urinary tract infection treatment on renal function[MP25,P75)]

    组别 n 血清肌酐(μmoI/L) 白细胞(×109/L)
    治愈 65
     治疗前 134(112,174) 8(7,10)
     治疗后 122(107,145)a 7(6,9)a
    未治愈 38
     治疗前 142(102,347) 7(5,10)
     治疗后 128(99,181) 7(5,10)
      注:与治疗前比较,aP<0.05。
    下载: 导出CSV
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