To analyze the characteristics of drug resistance and high risk factors of death of pathogenic bacteria of urogenic sepsis after endoscopic surgery for upper urinary tract calculi.

The clinical data of 108 patients with upper urinary tract calculi treated by endoscopy in the Affiliated Hospital of Chifeng University from January 2016 to January 2022 were analyzed retrospectively. They were divided into death group and cure group according to the prognosis. The characteristics of pathogen drug resistance were analyzed. At the same time, multivariate unconditional logistic regression model was used to analyze the high-risk factors of urogenic sepsis death after endoscopic surgery for upper urinary calculi, which was analyzed from four aspects: preoperative, surgical, ICU and pathogen related factors.

There were 21 patients in death group and 87 in the cure group. 108 strains were cultured, including 85 strains of gram-negative bacteria (78.70%), 21 strains of gram-positive bacteria (19.44%) and 2 strains of fungi (1.85%). The top three gram-negative bacteria were Escherichia coli, Serratia marcescens and Pseudomonas aeruginosa. The top three gram-positive bacteria were Enterococcus faecalis, Enterococcus faecium and Staphylococcus aureus. The fungi included Candida tropicalis and Candida albicans. 16 strains of extended-spectrum β lactamases (ESBLs) producing bacteria were detected in gram-negative bacteria, and 4 strains of Methicillin-resistant Staphylococcus aureus (MRSA) were detected in gram-positive bacteria. Among gram-negative bacteria, the drug resistance rate of Escherichia coli to Cefuroxime was 88.57%, the drug resistance rate of Serratia marcescens to Cefuroxime and Cefotaxime was 83.33%, the drug resistance rate of Pseudomonas aeruginosa to Levofloxacin was 44.44%, and the drug resistance rate of gram-positive bacteria to Erythromycin was 100%. Univariate analysis showed that female, diabetes, autoimmune diseases, preoperative bacterial positive urine, operation time, acute physiology and chronic health status (APACHE II) score, sequential organ failure assessment (SOFA) score and ESBLs producing bacteria were the related factors of death after urinary calculi surgery (P<0.05). Multivariate logistic regression analysis showed that female, diabetes, autoimmune disease, APACHE II score, SOFA score and ESBLs producing bacteria were independent risk factors for death.

Gram-negative bacteria are the main pathogens of urinary tract sepsis after endoscopic surgery for upper urinary tract calculi and the resistance rate is high. Female, diabetes, autoimmune diseases, APACHE II score, SOFA score and ESBLs producing bacteria are risk factors for death.