Clinical characteristics analysis of perioperative urinary tract infections in patients with immune dysfunction and renal calculi treated with flexible ureteroscopy
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摘要: 目的 评估免疫功能受损患者接受输尿管软镜碎石术(retrograde intrarenal surgery，RIRS)的围手术期泌尿系感染(urinary tract infection，UTI)风险。 方法 本研究为单中心回顾性病例对照研究，纳入2013年1月—2023年12月于北京协和医院接受RIRS的患者。病例组为免疫功能受损患者，对照组为无免疫受损情况的患者。通过Guy's评分进行2∶1匹配，记录人口统计数据、手术结果和UTI情况。采用χ2检验和Student's t检验进行统计分析，并进行多因素分析计算比值比(OR)及95%置信区间(CI)。 结果 共纳入258例患者，其中86例为免疫受损患者。免疫受损患者术前尿液培养阳性比例更高(P＜0.05)，且术后UTI比例也更高(P＜0.05)。2组结石清除率比较差异无统计学意义(P>0.05)，但病例组术后发热、尿培养阳性率、亚硝酸盐阳性率和感染性休克发生率均显著高于对照组(P＜0.05)。多因素分析显示，女性、糖尿病、术前尿培养阳性和肾积水是术后UTI的危险因素(P＜0.05)。 结论 免疫功能受损患者接受RIRS后UTI风险显著升高，尤其是女性、糖尿病患者、术前尿培养阳性和有肾积水的患者。本研究强调了对免疫功能受损患者进行RIRS时，需要更加严格的围手术期感染控制措施。未来的前瞻性研究将进一步探索全流程感染控制策略。Abstract: Objective To evaluate the risk of perioperative urinary tract infection(UTI) in patients with compromised immune function undergoing retrograde intrarenal surgery(RIRS). Methods This study was a single-center retrospective case-control study, including patients who underwent RIRS from January 2013 to December 2023. The case group consisted of patients with compromised immune function, and the control group consisted of patients without immune impairment. Patients were matched at a ratio of 2∶1 using Guy's score, and demographic data, surgical outcomes, and UTI cases were recorded. Chi-square tests and Student's t-tests were used for statistical analysis, and multivariate analysis was performed to calculate the odds ratio(OR) and 95% confidence interval(CI). Results A total of 258 patients were included, of which 86 were patients with compromised immune function. Patients with compromised immune function had a higher rate of positive preoperative urine cultures(P < 0.05) and a higher rate of postoperative UTI(P < 0.05). There was no significant difference in stone clearance rates between the two groups(P>0.05), but the incidences of postoperative fever, positive urine culture rates, nitrite positivity, and septic shock were significantly higher in the case group than in the control group(P < 0.05). Multivariate analysis showed that female gender, diabetes, positive preoperative urine culture, and hydronephrosis were risk factors in postoperative UTI(P < 0.05). Conclusion Patients with compromised immune function have a significantly increased risk of UTI after RIRS, especially female patients, those with diabetes, those with positive preoperative urine cultures, and those with hydronephrosis. This study emphasizes the need for more stringent perioperative infection control measures in patients with compromised immune function undergoing RIRS. Future prospective studies will further explore comprehensive infection control strategies.
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表 1 2组患者基线资料比较
例(%)，X±S 项目 病例组(86例) 对照组(172例) P值 年龄/岁 48.25±8.16 50.22±9.85 0.111 男性 26(30.23) 68(39.53) 0.143 BMI/(kg/m2) 26.21±7.11 25.36±8.39 0.421 右侧 49(56.98) 86(50.00) 0.290 糖尿病 22(25.58) 38(22.09) 0.532 Guy's评分 0.156 1 29(33.68) 58(33.66) 2 20(23.16) 41(23.76) 3 25(29.47) 49(28.71) 4 12(13.68) 24(13.86) 术前UTI 36(41.86) 50(29.07) 0.040 
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表 2 2组术中和术后的指标比较
例(%)，X±S 指标 病例组(86例) 对照组(172例) P值 手术时间/min 95.21±11.19 92.78±10.08 0.080 结石清除 75(87.12) 159(92.33) 0.173 结石成分(鸟粪石) 14(16.28) 13(7.56) 0.031 留置导尿管时间/d 1.87±0.16 1.85±0.13 0.283 住院时间/d 3.20±1.99 3.08±0.96 0.541 术后UTI 20(23.26) 21(12.21) 0.022 术后发热 20(25.58) 26(15.12) 0.042 术后血培养阳性 18(20.93) 20(11.63) 0.047 亚硝酸盐阳性 36(41.86) 24(13.95) ＜0.001 术后感染性休克 6(6.98) 2(1.16) 0.031
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表 3 病例组术前尿培养情况和术后血培养的情况
例(%) 细菌类型 术前尿培养 术后血培养 革兰氏阴性菌 26(72.22) 大肠埃希菌 17(47.22) 10(55.56) 肺炎克雷伯菌 6(16.67) 4(22.22) 铜绿假单胞菌 2(5.56) — 奇异变形菌 1(2.78) — 革兰氏阳性菌 7(19.44) 粪肠球菌 3(8.33) 2(11.11) 金黄色葡萄球菌 2(5.56) 1(5.56) 溶血葡萄球菌 1(2.78) — 屎肠球菌 1(2.78) 1(5.56) 真菌 3(8.33) 白色念珠菌 3(8.33) —
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表 4 病例组术后发生UTI的危险因素
因素 OR 95%LL 95%UL 年龄 0.78 0.24 1.37 性别(女vs男) 1.53 1.18 1.86 病史长短 1.05 0.69 1.71 糖尿病 1.42 1.17 1.75 术前尿路感染(是vs否) 2.11 1.56 2.83 肾积水(是vs否) 1.67 1.07 2.19 手术时间 1.08 0.86 1.32
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