A Clinical Study On The Relationship Between Bacterial Species In Preoperative Urine Culture And Infection After Percutaneous Nephrolithotomy For Upper Urinary Calculi

ObjectivesTo study the correlation between the types of urine culture bacteria before operation and postoperative infection in patients with upper urinary calculi treated by percutaneous nephrolithotripsy,and to further explore the distribution of urinary tract infection bacteria and the clinical characteristics of different bacterial infections in our hospital.MethodsCollected 963 patientswhich underwent Percutaneous Nephrolithotomybetween January 2014 and January 2020 in fujian provincial hospitaland Fujian provincial Jinshan hospital.Their gender,age,weight,chronic disease,preoperative infections,preoperative urine cultureresultsand postoperative infection wererecorded.Independent sample t test was used for the normal distribution data.Rank sum test was used for the non-normal distribution data.Chi-square test was used for the contrast of count data.Binary logistic regression was used to analyze the independent risk factors for postoperative infection.ResultsUnifactorial analysis of 963 patients showed that long operation time and positive urine culture were risk factors for postoperative infection,with P values of 0.024 and0.001,respectively.Multi-factor analysis showed that the independent risk factors of postoperative infection were: positive urine culture,OR value was 4.184;operation time,OR value was 1.006;The number of positive cases in preoperative urine culture was141(14.6%),and escherichia coli was the most common in urine culture,accounting for43.9%.The top five most abundant bacteria were escherichia coli,enterococcus faecalis,klebsiella pneumoniae,proteus strangis and enterobacter cloacae.The incidence of postoperative infection in patients with escherichia coli was higher than that in urine culture negative patients(P < 0.001).The postoperative infection of enterococcus faecalis and klebsiella pneumoniae patients progressed to septic shock.Escherichia coli infection is usually characterized by high fever and significant increase of procalcitonin,often exceeding 100ng/m L.Preoperative routine urine nitrite is usually positive,and most of them are female patients.Enterococcus faecalis infection is characterized by high fever and a significant increase in procalcitonin,often exceeding 20ng/m L,mostly in elderly patients.Klebsiella pneumoniae infection showed moderate fever,and the increase of procalcitonin was lower than that of e.coli and enterococcus faecalis group,mostly elderly and diabetic patients.ConclusionsPostoperative PCNL infection was significantly correlated with positive preoperative urine culture.Positive preoperative urine culture and long operative time were independent risk factors for postoperative infection.The most common pathogenic bacteria are escherichia coli,followed by enterococcus and klebsiella pneumoniae.Escherichia coli is a risk factor for postoperative PCNL infection.Once enterococcus and klebsiella pneumoniae cause postoperative infection,they can easily develop into septic shock.