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中华实验和临床感染病杂志(电子版) ›› 2017, Vol. 11 ›› Issue (06) : 561 -567. doi: 10.3877/cma.j.issn.1674-1358.2017.06.008

临床论著

前列腺穿刺活检术后感染性并发症的回顾性研究
程龙1, 陈弋生1,(), 邹滨1, 陶凌松1, 孔艰1, 朱光标1, 王家伟1, 陶良俊1   
  1. 1. 241000 芜湖市,芜湖市第二人民医院泌尿外科,芜湖市前列腺疾病研究所
  • 收稿日期:2016-11-09 出版日期:2017-12-15
  • 通信作者: 陈弋生

Retrospective study of infectious complications of prostate biopsies

Long Cheng1, Yisheng Chen1,(), Bin Zou1, Lingsong Tao1, Jian Kong1, Guangbiao Zhu1, Jiawei Wang1, Liangjun Tao1   

  1. 1. Department of Urology, Institute of Prostatic Diseases, The Second People’s Hospital of Wuhu, Wuhu 241000, China
  • Received:2016-11-09 Published:2017-12-15
  • Corresponding author: Yisheng Chen
引用本文:

程龙, 陈弋生, 邹滨, 陶凌松, 孔艰, 朱光标, 王家伟, 陶良俊. 前列腺穿刺活检术后感染性并发症的回顾性研究[J/OL]. 中华实验和临床感染病杂志(电子版), 2017, 11(06): 561-567.

Long Cheng, Yisheng Chen, Bin Zou, Lingsong Tao, Jian Kong, Guangbiao Zhu, Jiawei Wang, Liangjun Tao. Retrospective study of infectious complications of prostate biopsies[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2017, 11(06): 561-567.

目的

分析前列腺穿刺术后感染的相关危险因素及抗菌药物方案的选择。

方法

回顾性分析2013年1月至2016年6月本院泌尿外科收治的750例接受前列腺穿刺活检患者的临床资料。根据穿刺前预防性使用抗菌药物分为口服喹诺酮类组(A组)及静脉应用三代头孢类组(B组)。记录两组患者年龄、前列腺体积、收缩压、舒张压,体质指数,术前1周是否曾留置导尿,是否合并糖尿病以及术后的病理结果。统计术后1周内两组患者血尿、血精、血便及感染的发生率,分层比较各指标及两种抗菌药物方案下的感染发生率。

结果

750例患者感染发生率约为6.4%。年龄75岁及以上、合并糖尿病、术前1周内曾留置导尿以及术后1周内出现血尿、血精、血便的患者感染率更高。通过Logistic回归检验,结果显示年龄75岁及以上、合并糖尿病、术前1周内留置导尿以及术后出现血尿、血精、血便是前列腺穿刺活检术后感染的独立危险因素,感染率与体质指数、收缩压、前列腺体积及术后病理为前列腺炎或前列腺癌无关(P均> 0.05)。A组患者中年龄75岁及以上、术前1周内曾留置导尿以及术后1周内出现血尿、血精、血便的患者穿刺后感染率显著高于B组(P均> 0.05)。

结论

年龄、糖尿病、术前7 d留置导尿管及术后1周内出现血尿、血精、血便可能是前列腺穿刺术后感染的危险因素。对年龄75岁以上、术前7 d内曾留置导尿及术后7 d内出现血尿、血精、血便的患者,三代头孢类药物静脉应用可能会有更好的预防效果。

Objective

To investigate the risk factors of infection-related complications after prostate biopsies and to select an efficacy and suitable prophylactic regimen.

Methods

Clinical data of 750 patients who underwent prostate biopsy from January 2013 to April 2016 were analyzed, retrospectively; these patients were divided into two groups according to different prophylactic antibiotics as Group A (n = 237, quinolone oral applied) and Group B (n = 513, intravenous third generation cephalosporin). Baseline data and complications within one week following prostate biopsies were collected and the infectious complications were compared stratified by possible influence factors and two kinds of different prophylactic antibiotic.

Results

The occurrence of infectious complications of total 750 cases was 6.4%. The infection rate of patients ≥ 75 years, combined with diabetic, hematuresis, hematospermia, bloody stool after prostate biopsies and with retention catheterization in one week was higher than other patients (all P < 0.05). The infection rate of group A was higher than that of group B with three conditions: age ≥ 75 years, retention catheterization before biopsies in 1 week hematuresis, hematospermia, bloody stool after prostate biopsies, but was not related to other factors (all P > 0.05).

Conclusions

Diabetes, age, retention catheterization and hematuresis, hematospermia, bloody stool were the independent risk factors of infection after prostate biopsy. Intravenous third generation cephalosporin vein application could have better preventive effect.

表1 750例患者的基线资料( ± s
表2 患者临床指标与感染发生率的相关性
指标 总例数(n = 750) 感染例数(n = 48) χ2 P A组(感染例数/总例数) B组(感染例数/总例数) χ2 P
年龄(岁)     2.173 0.095 21/237 27/513 3.546 0.077
  < 60 84 3 0.651 0.347 1/37 2/47 0.315 0.728
  60~75 396 21 0.804 0.232 9/132 12/264 0.649 0.349
  ≥ 75 270 24 4.830 0.043 11/68 13/202 7.277 0.024
BMI(kg/m2     0.270 0.866        
  < 20 121 7 0.391 0.675 3/36 4/85 0.640 0.423
  20~25 522 33 0.285 0.872 14/169 19/353 0.801 0.248
  ≥ 25 107 8 0.377 0.668 4/32 4/75 0.787 0.236
血压(mmHg)     0.956 0.161        
  正常 516 30 0.438 0.503 14/172 16/344 0.971 0.115
  高血压病史< 15年 143 8 0.303 0.849 3/38 5/105 0.603 0.438
  高血压病史≥ 15年 91 10 3.947 0.067 4/27 6/64 0.563 0.476
前列腺体积(ml)     0.189 0.922        
  < 30 132 8 0.336 0.752 3/45 5/87 0.173 1.000
  30~60 326 20 0.270 0.881 9/106 11/220 0.725 0.337
  ≥ 60 292 20 0.324 0.760 9/86 11/206 0.918 0.130
糖尿病     6.250 0.042        
  654 35     15/214 20/440 0.860 0.198
  96 13     6/23 7/73 0.197 0.075
术前7 d内曾留置导尿     5.830 0.016        
  686 39     16/220 23/466 1.030 0.220
  64 9     5/17 4/47 5.843 0.048
术后7 d内出现血尿、血精、血便     5.173 0.038        
  501 25     10/173 15/328 0.428 0.667
  249 23     11/64 12/185 9.025 0.021
病理结果     0.255 0.936        
  非CP非Pca 284 17 0.316 0.761 5/86 12/198 0.273 0.936
  CP 239 16 0.299 0.873 7/67 9/172 0.939 0.153
  Pca 227 15 0.312 0.872 7/79 8/148 0.672 0.401
表3 前列腺穿刺活检术后感染并发症危险因素的Logistic回归检验
表4 术后感染者血/尿细菌培养结果[例(%)]
表5 术后感染者血/尿样本分离菌株对主要药物敏感试验
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