A Single Center Retrospective Analysis Of Related Risk Factors Of Urinary Stone Disease Concurrent Urinary Tract Infection And The Etiological Characteristics In Tibet

Objective To provide a basis for the prevention of urinary stone disease concurrent infection and to provide a standardized treatment program for guiding the application of antibiotics drugs during the perioperative period by investigating the related risk factors of urinary stone disease concurrent infection,examining the structure of the pathogenic bacteria and the susceptible rate of durgs and retrospectively analyzing the common risk factors of urinary stone disease concurrent infection,the spectrum of bacteria and the susceptible rate of common bacteria in Tibet,as well as to make up for the gaps in the etiology and associated risk factors of urinary tract infection concurrent urinary stone disease in high altitude areas.Methods From October 2015 to February 2018 in the People’s Hospital of Tibet Autonomous Region urology,585 cases of urinary stone disease patients,who were performed by extracorporeal shock-wave lithotripsy(ESWL),percutaneous nephrolithotomy(PCN L),ureteroscopic lithotripsy(URL),laparoscope lithotomy,and open surgical lithotripsy,were collected by a single center retrospective analysis,according to inclusion criteria and exclusion criteria.The i-ncidence in patients with different clinical characteristics and the distinction of various risk factors contributing to urinary tract infectio n concurrent urinary calculi are studied and analyzed by χ2.Multi-variate logistic regression analysis was used to investigate the risk f-actors of urinary calculi associated with urinary tract infection.The bacterial spectrum and drug sensitivity rate of patients with infection were statistically analyzed using χ2.Results 160 cases of bacterium are detected out of 585 urinary samples,with the positive rate being 27.3%.Univariate analysis showed that the urinary tract infection rate of female with urinary stone disease was significantly higher than that of male(44.40% vs17.52%,P=0.0001);the urinary tract infection rate of patients with u-rinary stone disease with a history of anti-infective drugs was significantly higher than that of without a history of anti-infective drugs(35.80% vs 23.60%,P=0.002);the urinary tract infection rate of patients with urinary stone disease with diabetes was significantly h-igher than that of without diabetes(34.4% vs28.40%,P=0.0001);the urinary tract infection rate of patients with urinary stone disease with staghorn calculus was significantly higher than that of non-staghorn calculus(62.50% vs 27.78%,P=0.002);the urinary tract infection rate of patients with urinary stone disease with lower urinary tract calculus was significantly higher than that of upper urinary tract calculus(31.32% vs 18.64%,P=0.002);the urinary tract infection rate of herdsman with urinary stone disease was significantly higher than that of non-herdsman(30.27%vs20.35%,P=0.003);the u-rinary tract infection rate of patients with urinary stone disease with hydronephrosis was significantly higher than that of without hydr-o nephrosis(33.41% vs 10.62%,P = 0.002);the urinary tract infection rate of patients with urinary stone disease with urinary tract obstruction was significantly higher than that of without urinary tract obstruction(59.38 %vs27.28%,P=0.0001).so the sex,age,occupation,hydronephrosis,using of anti-infective drugs,diabetes mellitus,antler-like kidney stones,multi-site stone and whether exists obstruction and so on are closely related to the patients with urinary stone disease with urinary tract infection;The results were statistically significant(P<0.05).Multi-factors Logistic regression analysis showed that females,senior citizens,herdsmen,basic diseases of diabetes,history of using of anti-infective drugs,lower urinary tract stones,staghorn calculi,urinary tract obstruction,and hydronephrosis are a risk factor for urinary stones diseases concurrent urinary tract infections(P<0.05).but there was no significant correlation between smoking,drinking,ethnicity,education,body mass index,number of stones,and hypertension(P>0.05).A total of 160 strains of pathogens are collected,including gram-negative bacteria 124 strains(77.5%)and gram-positive bacteria 36 strains(22.5%).The common top five bacteria were E.coli 107 strains(66.9%),Staphylococcus aureus 13 strains(8.1%),Proteus mirabilis and Staphylococcus epidermidis eachother 7 strains(4.4%),5 strains(3.1%)of E.faecium,5 strains of Enterococcus faecalis and 4 strains of K.pneumoniae(2.5%).The results of antimicrobial susceptibility rates showed that among the gram-negative bacteria,Escherichia coli,Proteus mirabilis,Pseudomo nas aeruginosa and Klebsiella pneumoniae against cefoperazone/sulba ctam sodium,piperacillin/he Zolbactam,minocycline,and imipenem have a low resistance rate(<10.0%),but are particularly sensitive to imipenem(100%);however,for ampicillin/sulbactam sodium,quinol ones(levofloxacin)have a low resistance rate(>90.0%);of which Proteus mirabilis and Pseudomonas aeruginosa exhibited absolute resistance to ampicillin/sulbactam sodium and levofloxacin(100%).The resistance rates of Escherichia coli to ceftriaxone,cefotaxime,ceftazidime and cefepime respectively were: 47.7%,48.6%,21.5% an d 22.4%;Klebsiella pneumoniae and Pseudomonas aeruginosa is similar to E.coli of the drug resistance rate.Among common gram-positive bacteria,Staphylococcus aureus has a high resistance rate to penicillin,ampicillin/sulbactam sodium and azithromycin(>50%),a nd the drug resistance rates respectively are 76.9%,53.8%,and 51.2%.The resistance rates to erythromycin,cefoxitin,cotrimoxazole,cefotaxime,cefuroxime,gentamicin,and levofloxacin were lower,re-s pectively15.3%,15.4%,23.1%,23.1%,30.8%,32.7% and 30.8%;but absolute sensitivity(100%)to moxifloxacin,rifampicin,teicoplanin and vancomycin.Staphylococcus epidermidis resistant to antibiotics was similar to Staphylococcus aureus;Enterococcus faecalis and Enterococcus faecalis were resistant to erythromycin,levofloxacin,and gentamicin(>70%),and the drug resistance rates were 80%,80%,and 70%;20% lower resistance to rifampin,and absolutely sensitive(100%)to ampicillin/sulbactam,teicoplanin,and vancomycin.Conclusion Females,senior citizens,herdsmen,basic diseases o-f diabetes,history of using of anti-infective drugs,lower urinary tract stones,staghorn calculi,urinary tract obstruction,and hydronephr osis are a risk factor for urinary stones diseases concurrent urinary tract infections.At present,the pathogens of urinary calculi with ur-inary tract infection are also dominated by gram-negative bacilli,fo-llowed by gram-positive bacteria in Tibet.The results of urinary bacterial culture were mainly Escherichia coli,Staphylococcus aureus,Proteus mirabilis,Staphylococcus epidermidis,Enterococcus faecium,Enterococcus faecalis,and Escherichia coli was still the main one.The combined preparations of cefoperazone/sulbactam sodium and piperacillin/tazobactam can be used as empiric antibacterial agents for patients with urinary stone disease concurrent urinary tract infection with gram-negative bacilli such as Escherichia coli;Ampicillin and Pipera Xilin,amoxicillin,clavulanic acid,ampicillin/sulbactam c-an be used as empiric drugs for patients with enterococcal urinary stone disease concurrent urinary tract infection;Cefoxitin,cefotaxim e,cefuroxime,cotrimoxazole and levofloxacin can be used as an empirical drug for patients with urinary stone disease concurrent urinary tract infection in Staphylococcus aureus and Staphylococcus epidermidis.However,the resistance of ampicillin/sulbactam and urotonin in gram-negative bacteria is gradually increasing,and it is not recommended as an empirical drug choice.Therefore,the results o-f bacterial culture and drug sensitivity test report should be used a-s the gold standard to guide the rational use of antimicrobial drugs in clinical treatment.In this study,due to uncontrollable factors such as high plateau anoxia,low atmospheric pressure,and unsatisfactory testing instruments and equipment,the lack of anaerobes,fung i,mycoplasma,and chlamydia and so on specific strains in patients with urinary stone disease concurrent urinary tract infection of the bacteria distribution and the analysis of susceptible rate of durgs;At the same time,The study have shown that the incidence of urinary stone disease in infants and young children is higher in Tibet.In this paper,the lack of analysis is risk factors,bacterial distributi on and susceptible rate of durgs with urinary stone disease concurre nt urinary tract infection in different age groups,especially infants and young children.In addition,this study shows that there are significant differences in the risk factors of upper and lower urinary t-ract calculi concurrent infection and in the bacterial distribution characteristics and susceptible rate of durgs;However,due to limited time and energy,there is no specific analysis of the differences in risk factors and specific bacterial species and drug susceptibility.F-inally,in this study,the lack of trial drugs used resulted in a low of accuracy of the susceptible rate of durgs.