| Background and Objective:Bladder cancer is a common malignant tumor of the urinary system that originates from the bladder,and its incidence rate ranks first among urinary system tumors and it is of great clinical harm.Surgical resection is the main treatment method for patients with bladder cancer,but there is the possibility of postoperative urinary tract infection which will cause great harm to life health and quality of life of patients.This study statistically analyzes the incidence rate of postoperative urinary tract infection in patients with bladder cancer,studies the main pathogenic microorganisms of postoperative urinary tract infection,analyzes the main risk factors leading to postoperative urinary tract infection and explores the influence on Toll-like receptors 4(TLR4)/Cyclic adenosine monophosphate(cAMP)signaling pathways with the hope of providing more ideas for the clinical treatment of patients with urinary tract infection after bladder cancer surgery.Methods:2,195 patients undergoing bladder cancer surgery in the hospital were retrospectively collected between January 2016 and January 2021,and the patients were divided into infected group(n=26)and non-infected group(n=2,169)according to whether postoperative urinary tract infection occurred.The incidence rate of postoperative urinary tract infection was statistically analyzed,and automatic microbial identification instrument was used to identify the pathogenic bacteria,and univariate analysis and multivariate regression analysis were performed on the risk factors that led to the increased risk of infection.In addition,fasting peripheral venous blood from the two groups of patients in the morning was collected and peripheral blood mononuclear cells(PBMC)were separated.Real-time fluorescent quantitative PCR was adopted to detect the mRNA expression levels of TLR4 and Adenylyl cyclase 3(AC3)in PBMC,and Western Blot was applied to detect the protein expressions of TLR4,AC3 and Ras-related C3 botulinum toxin substrate1(Rac1)in PBMC.Enzyme linked immunosorbent assay(ELISA)was used to detect the content of cAMP in peripheral blood,and Protein Kinase A(PKA)kit was used for the content of PKA in peripheral blood.Results:1.(1)Among the 2,195 patients who underwent bladder cancer resection,there were 26 cases of postoperative nosocomial infections,with the infection rate of 1.18%.(2)26 sterile urine samples were successfully collected in the middle of the morning from 26 patients with urinary tract infection after bladder cancer surgery.A total of 35 strains of pathogenic bacteria were isolated by laboratory culture identification,including 12 strains of Gram-positive bacteria(34.29%)[5 strains of Enterococcus faecalis(14.30%),2 strains of Enterococcus faecium(5.71%),2 strains of Staphylococcus aureus(5.71%),1 strain of Staphylococcus epidermis(2.86%),2 strains of other species(5.71%)],20 strains of Gram-negative bacteria(57.14%)[9 strains of Escherichia coli(25.71%),4 strains of Pseudomonas aeruginosa(11.43%),3 strains of Klebsiella pneumoniae(8.57%),1 strain of Enterobacter cloacae(2.86%)and 2 strains of other species(5.71%)]and 3 strains of fungi(8.57%)[2 strains of Candida(5.71%)and 1 strain of candida mycoderma bacteria(2.86%)].(3)Univariate analysis showed that there was no significant correlation among gender of patients,presence or absence of hypertension and occurrence of postoperative urinary tract infection(P>0.05).The occurrence of postoperative urinary tract infection was correlated with age above 60 years old,diabetes mellitus,preoperative catheterization for urinary retention,perioperative antibiotic use time exceeding 48 h,surgical time exceeding 60 min and postoperative extubation time longer than 5 d(P<0.05).(4)Multivariate Logistic regression analysis showed that age older than 60 years old,complicated with diabetes mellitus,preoperative catheterization for urinary retention,surgical time longer than 60 min and postoperative extubation time exceeding 5 d were the independent risk factors for urinary tract infection after bladder cancer surgery(P<0.05),and perioperative antibiotic use time exceeding 48 h was a protective factor for urinary tract infection after bladder cancer surgery(P<0.05).2.(1)The mRNA level and protein expression of TLR4 in PBMC cells were(3.28±0.23)and(2.88±0.24)in patients with urinary tract infection after bladder cancer surgery,and were(1.00±0.11)and(0.84±0.10)in patients without urinary tract infection after bladder cancer surgery.The mRNA expression level and protein expression of TLR4 in PBMC cells of infected group were significantly increased compared with those in non-infected group(P<0.05).(2)The mRNA level and protein expression of AC3 in PBMC cells were(2.41±0.30)and(2.10±0.20)in patients with urinary tract infection after bladder cancer surgery,and were(0.94±0.09)and(0.84±0.08)in patients without urinary tract infection after bladder cancer surgery.Compared with non-infected group,the mRNA expression level and protein expression of AC3 in PBMC cells were significantly enhanced in infected group（P<0.05).(3)The peripheral blood cAMP content of patients with urinary tract infection after bladder cancer surgery was(19.69±1.67)ng/mL,and the peripheral blood cAMP content of patients without urinary tract infection after bladder cancer surgery was(10.46±0.94)ng/mL.The peripheral blood cAMP content was significantly risen in infected group compared to non-infected group(P<0.05).(4)The PKA content in peripheral blood was(25.97±1.87)ng/mL in patients with urinary tract infection after bladder cancer surgery and was(12.20±1.19)ng/mL in patients without urinary tract infection after bladder cancer surgery.Compared with non-infected group,the PKA content in peripheral blood of patients in infected group was significantly elevated(P<0.05).(5)The Racl activity level in peripheral blood was(1.12±0.14)in patients with urinary tract infection and was(2.41±0.17)in patients without urinary tract infection after bladder cancer surgery.The Racl activity level in peripheral blood of patients in infected group was significantly reduced compared with that in non-infected group(P<0.05).Conclusion:(1)The incidence rate of urinary tract infection after bladder cancer surgery is 1.18%.(2)Gram bacteria such as Escherichia coli,Enterococcus faecalis and Pseudomonas aeruginosa are the main pathogenic bacteria of postoperative urinary tract infection.(3)Age older than 60 years old,diabetes mellitus,preoperative catheterization for urinary retention and postoperative extubation time longer than 5 d are risk factors that increase the risk of postoperative urinary tract infection,and perioperative antibiotic use time exceeding 48 h is a protective factor for postoperative urinary tract infection.(4)The TLR4/cAMP signaling pathways are abnormally activated in the body of patients with urinary tract infection after bladder cancer surgery.(5)Compared with patients without urinary tract infection after bladder cancer surgery,the levels of TLR4,AC3,cAMP and PKA in peripheral blood are significantly increased while the activity of Racl is significantly reduced in infected patients. |
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