Analysis of bacterial spectrum and construction of a predictive model for postoperative sepsis in patients with upper urinary calculi and positive urinary cultures.

IF 4.2 2区 医学 Q1 INFECTIOUS DISEASES
Yizhou Wang, Meng Gao, Minghui Liu, Jinbo Chen, Zewu Zhu
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引用次数: 0

Abstract

Background: To analyze bacterial profiles, antibiotic resistance, and urosepsis risk factors in urine culture-positive (UC+) patients post-endoscopic lithotripsy.

Research design and method: Retrospectively, 806 UC+ patients (2016.3-2021.3) were stratified into urosepsis/non-urosepsis groups per Sepsis-3 criteria.

Results: Among 845 isolates (56 species), Escherichia coli dominated (46.8%), followed by Enterococcus faecalis (8.8%). Gram-negative bacteria exhibited high resistance to ampicillin, cefazolin, and cefuroxime. Multivariate analysis identified preoperative multidrug-resistant (MDR) bacteriuria (OR = 2.15), staghorn calculi (OR = 2.23), days of preoperative antibiotics use <3 (OR = 1.87), absence of nephrostomy (OR = 2.30), and postoperative WBC > 9.8 × 109/L (OR = 2.69) as independent sepsis predictors. A nomogram incorporating these factors achieved robust predictive accuracy. Preoperative antibiotic use for ≥3 days was inversely correlated with the risk of urinary sepsis as the duration of antibiotic administration increased.

Conclusions: Urosepsis incidence was 13.1% post-lithotripsy. Early risk stratification, targeted infection control, and antibiotic stewardship guided by urine susceptibility testing are critical for prevention.

上尿路结石和尿培养阳性患者术后脓毒症的细菌谱分析和预测模型的构建。
背景:分析尿培养阳性(UC+)患者内镜下碎石术后的细菌谱、抗生素耐药性和尿脓毒症危险因素。研究设计与方法:回顾性研究806例UC+患者(2016.3-2021.3),根据脓毒症-3标准分为尿脓毒症组和非尿脓毒症组。结果:845株(56种)分离菌中,大肠杆菌占多数(46.8%),粪肠球菌次之(8.8%);革兰氏阴性菌对氨苄西林、头孢唑林和头孢呋辛具有高度耐药性。多因素分析发现术前多药耐药(MDR)菌尿(OR = 2.15)、鹿角结石(OR = 2.23)、术前抗生素使用天数(9.8 × 109/L) (OR = 2.69)是脓毒症的独立预测因素。结合这些因素的nomogram获得了稳健的预测准确性。术前抗生素使用≥3天随着抗生素使用时间的增加,尿脓毒症的发生风险呈负相关。结论:尿脓毒症的发生率为13.1%。早期风险分层,有针对性的感染控制,以及在尿药敏试验指导下的抗生素管理对预防至关重要。
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来源期刊
CiteScore
11.20
自引率
0.00%
发文量
66
审稿时长
4-8 weeks
期刊介绍: Expert Review of Anti-Infective Therapy (ISSN 1478-7210) provides expert reviews on therapeutics and diagnostics in the treatment of infectious disease. Coverage includes antibiotics, drug resistance, drug therapy, infectious disease medicine, antibacterial, antimicrobial, antifungal and antiviral approaches, and diagnostic tests.
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