Clinical characteristics and risk factors of 209 cases of urinary tract infection after kidney transplantation
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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7~12个月。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,治愈患者治疗后血清肌酐及白细胞水平较治疗前下降(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。 Abstract:Objective To investigate clinical characteristics and risk factors of different stages of urinary tract infection after kidney transplantation. Methods Clinical data of 209 kidney transplant recipients were retrospectively analyzed. According to time points of postoperative follow-up, all recipients were divided into 3 stages: within 1 month post-kidney transplantation, 1-6 months post-kidney transplantation, and 7-12 months post-kidney transplantation. The incidence of urinary tract infection, urine culture results of recipients with urinary tract infection and drug resistance characteristics of common pathogens during different stages after kidney transplantation were analyzed. The strains of patients with recurrent urinary tract infection were identified. The risk factors of urinary tract infection and the effect of urinary tract infection on renal allograft function were analyzed. Results The urinary tract infection rate was 90.0% in the first stage, 49.3% in the second stage and 22.5% in the third stage. The urinary tract infection rates of male recipients undergoing living-related organ donation in the second and third stages were lower than those of female recipients (both P<0.05). Urine culture test yielded positive results in 60 cases, and 84 strains of pathogenic bacteria were detected, mainly Gram-negative bacteria, among which Klebsiella pneumoniae accounted for the highest proportion. Sixty-six recipients had recurrent urinary tract infection, and the detected pathogens included Klebsiella pneumoniae, Escherichia coli and Candida glabrata, etc. Univariate analysis showed that postoperative use of antithymocyte globulin was the risk factor for urinary tract infection in the first stage. Preoperative urinary tract infection and donor type were the risk factors for urinary tract infection in the second stage. Gender and age of the recipients were the risk factors for urinary tract infection in the third stage. Multivariate analysis revealed that postoperative use of antithymocyte globulin was the risk factor for urinary tract infection in the first stage. Gender and age of the recipients were the risk factors for urinary tract infection in the third stage (all P<0.05). In the third stage, 65 cases were cured and 38 cases were not cured. In the treated recipients, the serum creatinine level and white blood cell count were decreased after corresponding treatment than those before treatment (both P<0.05). Conclusions Gram-negative bacteria are the main pathogens of urinary tract infection in kidney transplant recipients, and drug resistance is relatively high. Postoperative use of antithymocyte globulin, female and old age are the risk factors for urinary tract infection in kidney transplant recipients. -
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值 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 115 102(89) 76 66(87) 39 36(92) 0.572b 亲属活体器官捐献 94 86(91) 70 62(89) 24 24(100) 0.191b 第二时期 公民逝世后器官捐献 115 49(43) 76 31(41) 39 18(46) 0.303a 亲属活体器官捐献 94 54(57) 70 36(51) 24 18(75) 0.044a 第三时期 公民逝世后器官捐献 115 28(24) 76 15(20) 39 13(33) 0.108a 亲属活体器官捐献 94 19(20) 70 10(14) 24 9(38) 0.032b 注:a为χ2检验,b为连续性修正χ2检验。 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值 OR①(95% CI②) P值 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 $,μmoI/L) 987±278 885±276 合并术前尿路感染[n(%)] 2(10) 29(15) 0.746 透析方式[n(%)] 0.113 血液透析 16(76) 142(76) 腹膜透析 3(14) 42(22) 供者类型[n(%)] 0.447 0.504 公民逝世后器官捐献 13(62) 102(54) 亲属活体器官捐献 8(38) 86(46) 术后使用ATG[n(%)] 13(62) 70(37) 4.802 0.028 0.37(0.14~0.93) 0.034 注:①OR为比值比。 ②CI为可信区间。 表 3 第二时期受者发生尿路感染的危险因素分析
Table 3. Analysis of risk factors for urinary tract infection in recipients at the second period
项目 非尿路感染组(n=106) 尿路感染组(n=103) 单因素分析 多因素分析 χ2/t P值 OR①(95% CI②) P值 性别[n(%)] 2.229 0.135 男 79(75) 67(65) 女 27(25) 36(35) 年龄($\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 $,μmoI/L) 919±275 871±280 合并术前尿路感染[n(%)] 10(9) 21(20) 4.962 0.026 2.05(0.88~4.75) 0.096 透析方式[n(%)] 0.115 血液透析 80(75) 78(76) 腹膜透析 25(24) 20(19) 供者类型[n(%)] 4.556 0.033 0.63(0.36~1.13) 0.121 公民逝世后器官捐献 66(62) 49(48) 亲属活体器官捐献 40(38) 54(52) 术后使用ATG[n(%)] 41(39) 42(41) 0.096 0.757 注:①OR为比值比。 ②CI为可信区间。 表 4 第三时期患者发生尿路感染的危险因素分析
Table 4. Analysis of risk factors for urinary tract infection in recipients at the third period
项目 非尿路感染组(n=162) 尿路感染组(n=47) 单因素分析 多因素分析 χ2/t P值 OR①(95% CI②) P值 性别[n(%)] 7.997 0.005 2.70(1.36~5.36) 0.004 男 121(75) 25(53) 女 41(25) 22(47) 年龄($\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 注:①OR为比值比。 ②CI为可信区间。 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[M(P25,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。 -
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