髋关节置换术后留置尿管患者尿路感染真菌分布,耐药性及易感因素分析OACSTPCD

Objective To investigate the distribution characteristics,drug resistance,and susceptibility factors of urinary tract fungi infections caused by indwelling catheterization in patients undergoing hiparthroplasty(HA).Methods A total of 1923 patients with indwelling urinary catheters after HA surgery admitted to the Orthopedics Department ward 2 of the First Affiliated Hospital of the Air Force Medical University from January 2019 to December 2023 were divided into an experimen-tal group(infected)of 134 cases and a control group(uninfected)of 1789 cases based on whether urinary tract fungi infec-tions occurred.Clinical isolation of non repetitive fungal strains and analysis of the distribution characteristics of urinary tract fungal infections caused by indwelling catheterization after HA surgery;And conduct drug sensitivity tests to summarize the urinary tract fungal sensitivity rate(S)and drug resistance rate(R)of patients with postoperative indwelling catheterization;Collect clinical data,conduct univariate and multivariate logistic regression analysis,and construct a risk prediction model based on the probability values fitted by the regression equation.Results Among 134 patients with urinary tract fungal in-fections,a total of 148 non repetitive fungal strains were collected,mainly Candida albicans,accounting for 43.24％(64/148);next was Candida tropicalis,accounting for 22.97％(34/148).The drug sensitivity results showed that,except for Candida krusei,which was naturally resistant to fluconazole,all fungi showed different sensitivity rates to the three azoles.Among them,itraconazole had the highest resistance rate and was significantly less sensitive than fluconazole and voricon-azole(P＜0.05).Except for the two main detected fungi that maintained high sensitivity to 5-fluorocytosine and amphoteri-cin B(S＞90％),other fungi were completely sensitive to 5-fluorocytosine and amphotericin B(S=100％);All fungi are completely sensitive to caspofungin(S=100％).Logistic regression analysis showed that age,indwelling catheter time,in-dwelling catheter times,C-reactive protein(CRP),procalcitonin(PCT),(1,3)-β-D glucan,combined diabetes,use time of antibiotics,and use history of antibiotics were independent risk factors for urinary tract infection caused by indwelling cathe-ter after HA(P＜0.05);ROC analysis showed that age,duration of indwelling catheter,number of indwelling catheters,CRP,PCT,(1,3)-beta-D glucan,duration of antibiotic use,and combined prediction of postoperative fungal infection all had statistical significance(P＜0.05);There were no statistical significance in diabetes and postoperative fungal infection in the use of antibiotics(P＞0.05).Conclusion The pathogen of urinary tract fungal infection after HA surgery is mainly Candida albicans.Age,duration of indwelling catheter,number of indwelling catheter,CRP,PCT,(1,3)-β-D glucan,combined diabetes,duration of antimicrobial use,and history of antimicrobial use are the independent risk factors for postop-erative fungal infection.It is recommended to use antibiotics reasonably based on the characteristics of drug sensitivity,and take measures to actively prevent the above-mentioned risk factors.