Shokeir Ahmed A, Al Ansari Abdulla A
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Scand J Urol Nephrol. 2006;40(2):89-97. doi: 10.1080/00365590510031093.
In this paper we review the pathogenesis, prevention and management of iatrogenic infection in urological practice. A systematic literature search was conducted using MEDLINE. The topics discussed include the commonest home-care, outpatient, endourologic and open surgical procedures. In addition, we discuss iatrogenic urinary infections associated with special situations, including urinary diversion, urologic prostheses, diabetes mellitus, dialysis, kidney transplantation and complicated urinary tract infections (UTIs). The findings of the literature review are as follows. Prophylactic antibiotics are not recommended with clean intermittent catheterization. With prolonged catheterization, antibiotics should not be used unless symptoms of pyelonephritis or septicemia become apparent. With transrectal prostate biopsy, infection can be prevented by rectal cleansing, use of smaller needles and administration of antimicrobial prophylaxis before and after the procedure. With ureteral stents, antibiotics should be restricted to patients with clinical signs of infection and high-risk patients. Infections after transurethral resection of the prostate can be prevented by avoiding risk factors and using perioperative antibiotics. In endourological procedures, antibiotic prophylaxis is indicated in cases of infected stones, preoperative UTIs or prolonged procedures. Antibiotics are not recommended for clean wounds, as prophylaxis for clean-contaminated wounds or as therapy for contaminated and dirty wounds. In patients with urinary diversion, the objective is to prevent pyelonephritis by avoiding both reflux and obstruction of the upper urinary tract. In patients with urological prostheses, the most important measure to overcome iatrogenic infection is prevention. In dialysis patients, iatrogenic infections can be prevented by the development of new catheter materials that are less susceptible to biofilms. In kidney transplant recipients, iatrogenic infections can be prevented by treating all types of infection prior to transplantation and by using peri- and postoperative prophylactic antibiotics.
在本文中，我们回顾了泌尿外科实践中医源性感染的发病机制、预防和管理。使用医学文献数据库（MEDLINE）进行了系统的文献检索。讨论的主题包括最常见的家庭护理、门诊、腔内泌尿外科和开放手术操作。此外，我们还讨论了与特殊情况相关的医源性尿路感染，包括尿流改道、泌尿外科假体、糖尿病、透析、肾移植和复杂性尿路感染（UTI）。文献综述的结果如下。不建议在清洁间歇性导尿时使用预防性抗生素。对于长期留置导尿管，除非出现肾盂肾炎或败血症症状，否则不应使用抗生素。经直肠前列腺活检时，可通过直肠清洁、使用较小的针头以及在操作前后给予抗菌预防来预防感染。对于输尿管支架，抗生素应仅限于有感染临床体征的患者和高危患者。经尿道前列腺切除术后的感染可通过避免危险因素和使用围手术期抗生素来预防。在腔内泌尿外科手术中，对于感染性结石、术前尿路感染或手术时间延长的情况，应使用抗生素预防。不建议将抗生素用于清洁伤口、作为清洁-污染伤口的预防措施或作为污染和脏污伤口的治疗方法。在尿流改道的患者中，目标是通过避免上尿路反流和梗阻来预防肾盂肾炎。在有泌尿外科假体的患者中，克服医源性感染的最重要措施是预防。在透析患者中，可通过开发不易形成生物膜的新型导管材料来预防医源性感染。在肾移植受者中，可通过在移植前治疗所有类型的感染以及使用围手术期和术后预防性抗生素来预防医源性感染。
