Mariappan Paramananthan, Smith Gordon, Moussa Sami A, Tolley David A
Western General Hospital, Urology, Edinburgh, UK.
BJU Int. 2006 Nov;98(5):1075-9. doi: 10.1111/j.1464-410X.2006.06450.x.
To evaluate whether 1 week of ciprofloxacin before percutaneous nephrolithotomy (PCNL) in patients with stones of > or = 20 mm or pelvicalyceal dilatation, reduces urosepsis, as we previously reported that such patients have four times the risk of urosepsis after PCNL.
Patients undergoing PCNL, and who fulfilled strict selection criteria, were recruited prospectively into a study which was conducted in two phases. The study methods were similar to those previously described; patients with dilated pelvicalyceal systems and/or stones of > or = 20 mm from phase 1 (previously published) acted as controls. In the subsequent phase, the same selection criteria applied and only those with stones of > or = 20 mm and/or dilated pelvicalyceal systems were given ciprofloxacin 250 mg twice daily for 1 week before PCNL and comprised the treatment arm. Midstream urine samples, renal pelvic urine and fragmented stones were collected to assess culture and sensitivity. Systemic inflammatory response syndrome (SIRS) was used to define urosepsis after PCNL. The urologists monitoring the patients after PCNL and conducting the analysis were all unaware of the characteristics of the stones or intravenous urography findings before PCNL. In all, 115 patients (54 in phase 1 and 61 in phase 2) were recruited, of whom 46 in phase 1 and 52 in phase 2 had stones of > or = 20 mm and/or a dilated pelvicalyceal system, and became the control and treatment arms, respectively.
The patient demographics were similar in both arms. There was three times less risk of upper tract infection (relative risk 3.4, 95% confidence interval 1.0-11.8, P = 0.04) and SIRS (2.9, 1.3-6.3, P = 0.004) in the patients receiving ciprofloxacin (treatment arm).
The administration of oral ciprofloxacin for 1 week before PCNL in patients with stones of > or = 20 mm or dilated pelvicalyceal systems significantly reduced the risk of urosepsis.
评估对于结石直径≥20mm或肾盂肾盏扩张的患者，在经皮肾镜取石术（PCNL）前给予1周环丙沙星治疗是否能降低尿脓毒症的发生风险，因为我们之前报道过此类患者在PCNL术后发生尿脓毒症的风险是其他人的四倍。
前瞻性招募接受PCNL且符合严格入选标准的患者进入一项分两个阶段进行的研究。研究方法与之前描述的相似；第一阶段（已发表）中肾盂肾盏系统扩张和/或结石直径≥20mm的患者作为对照组。在随后阶段，应用相同的入选标准，仅那些结石直径≥20mm和/或肾盂肾盏系统扩张的患者在PCNL前1周给予环丙沙星250mg，每日两次，构成治疗组。收集中段尿样本、肾盂尿液和结石碎片以评估培养及药敏情况。采用全身炎症反应综合征（SIRS）来定义PCNL术后的尿脓毒症。监测PCNL术后患者并进行分析的泌尿外科医生均不知道PCNL术前结石的特征或静脉肾盂造影结果。总共招募了115例患者（第一阶段54例，第二阶段61例），其中第一阶段46例和第二阶段52例患者结石直径≥20mm和/或肾盂肾盏系统扩张，分别成为对照组和治疗组。
两组患者的人口统计学特征相似。接受环丙沙星治疗的患者（治疗组）发生上尿路感染的风险降低了三倍（相对风险3.4，95%置信区间1.0 - 11.8，P = 0.04），发生SIRS的风险降低了两倍（2.9，1.3 - 6.3，P = 0.004）。
对于结石直径≥20mm或肾盂肾盏系统扩张的患者，在PCNL前给予口服环丙沙星1周可显著降低尿脓毒症的风险。
