Asingle Center Retrospective Analysis Of Related Risk Factors And Etiological Characteristics Of Urinary Urinary Tract Infected Stone Disease In Gannan District

ObjectiveTo analyze the related risk factors,distribution characteristics of pathogenic bacteria and drug resistance of urinary calculus(UC)complicated with urinary tract infection(UTI)in the South of Jiangxi,to understand the etiological characteristics ofclean Mid Stream Urine(MSU)culture in UC patients with urosepsis after intracavity lithotripsy,as well as to make up for the gaps in this field in Gannan district,for urological surgeons prevention,diagnosis,and specification to provide reliable basis,to promote patients recover.MethodsWe collected clinical data of hospitalized patients who were diagnosed with UC associated with UTI during January 2016-December 2020 in the urology department of the First Affiliated Hospital of Gannan Medical University,the incidence and risk factors of UTI in UC patients,Pathogenic bacteriaanddrug resistance,characteristics ofpathogenic bacteria in urosepsis patients wereanalysed.ResultsⅠ Atotal of 8290 MSUspecimens were collected,UTI was diagnosed in4685 cases(56.5%),pathogenic microorganisms were isolated from 2199 cases,with the positive rate being 26.5%.Single factor analysis showed that gender,age,urinary tract obstruction,location,degree of hydronephrosis,cast stones,stone,stone composition,DM and so on are closely related to the patients with UC associated with UTI;The results were statistically significant(P<0.05).Multi-factors Logistic regression analysis showed that female [OR=3.023(1.291,1.358)],age≥45 years [OR=1.989(1.985,2.993)],cast calculi [OR=2.108(1.608,1.958)],urinary tract obstruction [OR=1.963(0.845,1.096)]are a risk factor for urinary stones diseases concurrent urinary tractinfections(P<0.05).Ⅱ A total of 2453 strains of 81 pathogenic microorganisms were isolated from 8290 MSU samples,including 1722 strains of 42 Gram-negative bacilli(GNB),502 strains of 28 Gram-positive Cocci(GPC)and229 strains of 11 fungi.1174 strains of Escherichiacoli(E.coli)was thepredominant isolate(47.9%)followed by 163 strains of Klebsiella pneumoniae(KPN)(6.6%),Enterococcus faecalis(E.faecalis)162 strains(6.6%),Enterococcus faecium(E.faecium)91 strains(3.7%),Proteus mirabilis(P.mirabilis)88 strains(3.6%),Staphylococcus haemolyticus(S.haemolyticus)78 strains(3.2%),Pseudomonas aeruginosa(PAE)66 strains(2.7%).The most common fungi were 108 strains of candida albicans(4.4%),36 strains of Candida tropical(1.5%),33 strains of Candida smooth(1.3%),18 strains of candida proxima smooth(0.7%)and 15 strains of Candida namescens(0.6%)respectively.There were 680 strains of E.coli from Extended Spectyumβ Lactamase(ESBLs)producers,accounting for 57.9%.131 strains of KPN from ESBLs producers,accounting for40.1%.Gender,age and DM were correlated with the distribution of pathogenic bacteria in UC patients with UTI(P< 0.05).Ⅲ The results of antimicrobial susceptibility rates showed that most GNB against cefoperazone/sulbactam(CPS),piperacillin/tazobactam(TZP),imipenem(IME),amikacin(AKN),tigecycline(TYGACIL)have a low resistance rate(<10.0%),but are particularly sensitive to ertapenem(INVANZ)(100%),high resistance rate to Ampicillin(APN)(≥ 88.0%),a variety of bacteria are insensitive to IME.A number of GPC against linezolid(LZD),vancomycin(VCM),TYGACIL,Nitrofurantoin(AHD),teicoplanin(TCP)have a low resistance rate(<10.0%),but are particularly sensitive to LZD,TYGACIL,TCP(100%),high resistance rate to Ampicillin(APN)(≥88.0%),the resistance rate of E.faeciu,Staphylococcus aureus(S.aureus),S.haemolyticus to penicillin G(PG)was higher(>90.00%),the VCM resistant strain was found in E.faecalis.Common fungi had high sensitivity to amphotericin B(Amp B),5-fluorouracil(5-FU),Voriconazole(VCZ),Miconazole(MCZ),Ecoozole(ECO)(>90.0%),particularly sensitive to Amp B(100%);Candida tropicalis and Candida glandularis have low sensitivity to Itraconazole(ITRA)(50.0% and 76.9%),all species of fungi showed resistance to5-FU,ITRA,fluconazole(FCZ),VCZ.Ⅳ There were 34 cases of UC patients associated with urosepsis after intracavity lithotripsy,and GNB was the main pathogenic microorganism isolated from preoperative MSU.There were 19 strains of E.coli(63.3%),3 strainsof E.faecium(10.0%),1 strain of enterobacter cloacae(E.cloacae)(1.3%),1strain of KPN(3.3%),1 strain of staphylococcus epidermidis(S.epidermidis)(3.3%),5 strains of fungi(16.7%).E.coli against APN,Ceftriaxone(CRO),Ciprofloxacin(CIP)have a high resistance rate(>50.0%),1 strain was resistant to INVANZ,1 strain was intermediary to IME,E.coli against TZP,CPS,INVANZ,IME have a lowresistance rate(<10.0%).ConclusionⅠ Female,age≥45years,staghorn calculi and urinary tract obstruction are considered as independentrisk factors.Ⅱ.Our study showed that GNB was the main pathogen of UC associated with UTI in Gannan district were mainly GNB,and E.coli,KPN,E.faecalis,E.faecium and P.mirabilis were the main pathogenic bacteria.Gender and age were related to the distribution and drug resistance of pathogens.Most GNBS have lowsensitivity to penicillins and cephalosporins,most GPC have higher drug resistance to PG.Pathogenic fungi are sensitive to most antifungal drugs,but Amp B and 5-FU arenot recommended tobe used first.Ⅲ E.coli was the main cause of after intracavitary lithotripsy,and it was resistant to multiple antibiotics.