Analysis Of Risk Factors And Countermeasures For Urinary Tract Infection After Laparoscopic Radicai Cystectomy And Ileocystostomy

Objective In this research,we retrospectively studied the occurrence of urinary tract infections(UTI)after laparoscopic radical cystectomy(LRC)and ileal bladder replacement in a urology department of a comprehensive tertiary Class A hospital.We analyzed the risk factors and protective factors of UTI after LRC and ileal bladder replacement,then enacted corresponding countermeasures based on risk factors to provide theoretical basis for the prevention of UTI after LRC and ileal bladder replacement.Method We retrospective analyzed the clinical data of patients undergoing LRC and ileal bladder surgery in a comprehensive tertiary Class A hospital from October 2015 to October 2019.187 cases were selected as research objects based on the inclusion and exclusion criteria.Among them,there were 31 patients with UTI after the operation and they were divided into the infection group.Among the patients in the infection group,they were matched with the non-infection group patients in the 1:2 ratio and strictly according to the matching conditions(admission time±15 days).16 clinical data were analyzed one by one statistically,including the gender,age,history of diabetes,smoking history and so on among all matched infected and non-infected patients.These data were counted as independent variables,while the UTI occurrence after surgery was countered as a dependent variable.All collected data were analyzed using SPSS22.0 software,and 16 clinical data and postoperative UTI were analyzed by univariate analysis.Factors with statistical significance(P<0.05)were included in multivariate logistic regression,the independent risk factors and protective factors of UTI after LRC and ileal bladder replacement were obtained.According to the risk factors,we consulted data and literature to formulate prevention and control measures.Result(1)With 187 patients,there were 31 patients with UTI who underwent LRC and ileal bladder replacement.The infection rate was 16.58%.(2)In this study,a total of 34 pathogenic bacteria were cultured in the urine of 31 patients with postoperative UTI,including 21 Gram-negative bacteria,accounting for 61.76%,10 Gram-positive bacteria,accounting for 29.41%,and three fungi,accounting for 8.82%.(3)The univariate analysis results showed that 7 factors including gender,diabetes,prophylactic antibiotic use,duration of surgery,postoperative anemia,smooth urine drainage,ostomy-related complications had statistically significant differences in whether UTI occurred after laparoscopic radical cystectomy(LRC)and ileal bladder replacement(P<0.05).(4)Multivariate logistic regression analysis results showed that gender,diabetes,and stoma-related complications were independent risk factors for UTI after LRC and ileal bladder replacement.Smooth urine drainage and preventive antibiotics used were protective factors for the occurrence of UTI after LRC and ileal bladder replacement.Conclusion(1)UTI after LRC and ileal bladder replacement is the result of a combination of factors.Smooth urine drainage and prophylactic use of antibiotics are protective factors.It is important to use antibiotics reasonably before surgery and strengthen the postoperative management of postoperative patients.(2)Gender,diabetes and stoma-related complications are independent risk factors for UTI after LRC and ileal bladder replacement.Female patients must be strengthened in preparation before surgery and vaginal irrigation should be given at regular intervals.The blood glucose level should be strictly controlled during the operation,as well as the postoperative stoma management and health education should be implemented to ensure the patient’s smooth recovery.