Fang Wenjuan,Chen Pengyu,Liu Xiaodong,et al.Risk factors for postoperative urinary tract infections in children with primary obstructive megaureter[J].Journal of Clinical Pediatric Surgery,2024,(04):341-347.[doi:10.3760/cma.j.cn101785-202403060-008]
原发性梗阻性巨输尿管症患儿术后尿路感染的危险因素分析
- Title:
- Risk factors for postoperative urinary tract infections in children with primary obstructive megaureter
- 关键词:
- 原发性梗阻性巨输尿管; 输尿管梗阻; 泌尿系感染; 危险因素; 儿童
- Keywords:
- Primary Obstructive Megaureter; Ureteral Obstruction; Urinary Tract Infections; Risk Factors; Child
- 摘要:
- 目的 探讨原发性梗阻性巨输尿管症患儿术后发生尿路感染的危险因素。 方法 回顾性分析2015年1月至2023年2月深圳市儿童医院泌尿外科收治的146例原发性梗阻性巨输尿管症患儿临床资料,其中男97例、女49例;左侧89例,右侧40例,双侧17例;年龄1个月至17岁,中位年龄1岁11个月。根据术后尿培养结果分为感染组(35例)和非感染组(111例)。收集两组患儿手术时间、手术方式、肾积水程度、输尿管宽度、术前血液学参数、术前尿常规白细胞计数、术后尿常规及尿培养结果以及是否留置双J管、尿管、膀胱造瘘管等资料,采用单因素分析、多因素Logistic回归分析原发性梗阻性巨输尿管症患儿术后发生尿路感染的危险因素。 结果 单因素Logistic回归分析结果显示:年龄≤1岁、术前尿常规白细胞计数>5个/高倍镜视野(high power field,HPF)、肾积水程度>3级是原发性梗阻性巨输尿管症患儿术后发生尿路感染的危险因素(P<0.05)。多因素Logistic回归分析结果显示:年龄≤1岁患儿术后发生尿路感染的风险是年龄>1岁患儿的3.462倍(OR=3.462,95%CI:1.245~9.629,P=0.017),术前尿常规白细胞计数>5个/HPF的患儿术后发生尿路感染的风险是术前尿常规白细胞计数≤5个/HPF患儿的5.451倍(OR=5.451,95%CI:2.277~13.045,P＜0.001),肾积水程度>3级的患儿术后发生尿路感染的风险是肾积水程度≤3级患儿的5.473倍(OR=5.473,95%CI:1.135~26.390,P=0.034)。 结论 年龄≤1岁、术前尿常规白细胞计数>5个/HPF以及合并严重肾积水的原发性梗阻性巨输尿管症患儿更易发生术后尿路感染。
- Abstract:
- Objective To explore the risk factors for postoperative urinary tract infections (UTIs) in children of primary obstructive megaureter (POM). Methods From January 2015 to February 2023,retrospective analysis was performed for the relevant clinical data of 146 POM children.There were 97 boys and 49 girls with a median age of 23(1-17) month.The involved side was left (n=89),right (n=40) and bilateral (n=17).According to the results of postoperative urinary culture,they were assigned into two groups of infected (n=35) and non-infected (n=111).Operative duration,surgical approach,severity of hydronephrosis,ureteral width,preoperative hematological parameters,leucocyte count of preoperative urine routine,postoperative urinary routine/culture,double J tubing or not,urinary catheterization and bladder fistulas were recorded.Statistical analysis was performed for risk factors for postoperative UTIs. Results The results of univariate Logistic regression analysis indicated that age ≤1 year,leucocyte count of preoperative urine routine >5/HPF and severity of hydronephrosis >3 were risk factors for postoperative UTIs (P<0.05).The results of multivariate Logistic regression analysis revealed that the risk of postoperative UTIs in children aged ≤1 year was 3.462 folds higher than that in those aged >1 year (OR=3.462,95%CI:1.245-9.629,P=0.017).The risk of postoperative UTIs in children with leucocyte count of preoperative urine routine >5/HPF was 5.451 folds higher than that those with leucocyte count of preoperative urine routine ≤5/HPF (OR=5.451,95%CI:2.227-13.045,P<0.001).The risk of postoperative UTIs in children with hydronephrosis >grade Ⅲ was 5.473 folds higher than that in those with hydronephrosis ≤ grade Ⅲ(OR=5.473,95%CI:1.135-26.390,P=0.034). Conclusions Young POM children with leucocyte count of preoperative urine routine >5/HPF are more prone to postoperative UTIs.
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备注/Memo
收稿日期:2023-04-13。
基金项目:国家自然科学基金委联合基金项目 (U1904208); 深圳市医学重点学科(2020—2024)(SZXK035)
通讯作者:李守林,Email:lishoulinsz@126.com