The Changes Of The Bacterial Spectrum And Drug Resistance Of Urinary Tract Infection Pathogens And Analysis Of Incidence Rate Of Urinary Tract Infection After Transurethral Plasma Kinetic Resection Of The Prostate And Its Related Risk Factors

Objective The changes of the bacterial spectrum and drug resistance of urinary tract infection pathogens have a direct impact on the prevention and treatment of urinary tract infection,the characteristics and drug resistance of pathogenic bacteria determine the choice of antimicrobial agents.The most common benign disease in the cause of dysuria of the middle and old aged men is benign prostatic hyperplasia,and its symptoms are more obvious with the increasing age.Surgical treatment should be used when the patient has indications of surgery and the systemic condition can be tolerated.Transurethral plasma kinetic resection of the prostate(TUPKRP)can be applied to most of the patients with benign prostate hyperplasia,it has lots of advantages and has become one of the reliable and effective operative methods for the treatment of benign prostate hyperplasia,but the troubled problem of the urinary surgeon is still the occurrence of postoperative urinary tract infection.So to explore the changes of the bacterial spectrum and drug resistance of urinary tract infection pathogens and incidence rate of urinary tract infection after TUPKRP and its related risk factors have important significance,to provide evidence for the selection of antibiotics in the treatment of urinary tract infection and the prevention of postoperative urinary tract infection.Methods Retrospective analysis of clinical data of 114 patients with urinary tract infection from January 2009 to November 2015 in department of urology and renal department of internal medicine of the first affiliated hospital of dalian medical university,78 cases among them were common urinary tract infection,and 36 cases were urinary tract infection after TUPKRP,88 cases have results of urinary bacteria culture among 114 patients with urinary tract infection,to analysis the changes of the bacterial spectrum and drug resistance of urinary tract infection pathogens.215 cases of patients with benign prostate hyperplasia were collected from department of urology of the first affiliated hospital of dalian medical university from January 2009 to November 2015.Using SPSS 17.0 statistical software to do descriptive statistics?Chi square test and multiple factors Logistic regression analysis to find out incidence rate of postoperative urinary tract infection and its related risk factors of the 215 cases of benign prostate hyperplasia patients with TUPKRP.Results Urinary bacteria culture results of 88 cases showed that gram negative bacilli accounted for 87.5%,gram positive cocci accounted for 12.5%,Escherichia coli infection among them accounted for 64.8% is the main pathogenic bacteria of urinary tract infection,Escherichia coli with ESBLs among all Escherichia coli accounted for 42.1%,the others were Klebsiella pneumoniae 11.4 % ? Fecal streptococcus 8%? Proteus mirabilis 5.7%.The multiple drug resistance rate of 88 bacteria samples was 48.9%,and the drug resistance rates of levofloxacin and tetracycline were 60.2% and 47.7% respectively,no strains resistant to imipenem ? meropenem and ertapenem.The drug resistance rates of Escherichia coli to sulfamethoxazole?cefepime,piperacillin,piperacillin / tazobactam,cefoxitin,and cefoperazone / sulbactam were 73.7%?59.6%?22.8%?14%and5.3% respectively,no strains resistant to imipenem?meropenem and ertapenem,Escherichia coli is sensitive to piperacillin / tazobactam,cefoxitin,cefoperazone / sulbactam,they can be used for prophylactic and empirical medication.The incidence rate of urinary tract infection after TUPKRP was 16.7%,the age of patients(?70 years)(OR=3.408,P=0.008)?diabetes(OR=2.930,P=0.038)?due to urinary retention for indwelling catheter before operation(OR=3.749,P=0.003)and indwelling catheter time after operation(>5 days)(OR=2.424,P=0.042)were related risk factors of urinary tract infection after TUPKRP,application of antibiotics in perioperative period(>48hours)(OR=0.410,P=0.032)was protective factor of urinary tract infection after TUPKRP.Conclusion Escherichia coli is the main pathogen of urinary tract infection,empirical medication should choose piperacillin / tazobactam?cefoxitin and cefoperazone / sulbactam.The incidence of urinary tract infection after TUPKRP is higher and the related risk factors are age(?70 years)? diabetes?preoperative catheterization and postoperative extubation time(>5 days),protective factor is application of antibiotics in perioperative period(>48hours).