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泌尿外科手术前对无症状菌尿进行评估和治疗对于降低术后有症状尿路感染的风险是否必要?

Is Preoperative Assessment and Treatment of Asymptomatic Bacteriuria Necessary for Reducing the Risk of Postoperative Symptomatic Urinary Tract Infections After Urologic Surgical Procedures?

作者信息

Cai Tommaso, Verze Paolo, Palmieri Alessandro, Gacci Mauro, Lanzafame Paolo, Malossini Gianni, Nesi Gabriella, Bonkat Gernot, Wagenlehner Florian M E, Mirone Vincenzo, Bartoletti Riccardo, Johansen Truls E Bjerklund

机构信息

Department of Urology, Santa Chiara Regional Hospital, Trento, Italy.

Department of Urology, University Federico II of Naples, Naples, Italy.

出版信息

Urology. 2017 Jan;99:100-105. doi: 10.1016/j.urology.2016.10.016. Epub 2016 Oct 20.

Abstract

OBJECTIVE

To evaluate whether it is always necessary to test for the presence of asymptomatic bacteriuria (AB) in patients undergoing urologic surgical procedures, and if present, whether to treat AB with antimicrobial prophylaxis.

MATERIALS AND METHODS

All patients who underwent urologic surgical procedures from December 2008 to October 2013 in a tertiary referral urologic center were considered for this study. All patients received antimicrobial prophylaxis in line with European Association of Urology guidelines on urologic infections. AB was diagnosed if ≥10 colony-forming units/mL were cultured. The population was subdivided into 2 groups: group A, patients with preoperative AB, and group B, patients without AB. Data on postoperative symptomatic urinary tract infections (UTIs) were compared for the 2 groups.

RESULTS

A total of 2201 patients were considered eligible for this study and were analyzed; 668 (30.4%) patients were found to harbor AB (group A), and 1533 (69.6%) patients did not have AB (group B). Microbiologically verified symptomatic postoperative UTIs occurred in 198 patients (8.9%). No difference in terms of overall rate of postoperative symptomatic UTI was found between the 2 groups (group A: 70 [10.4%] and group B: 128 [8.3%]; OR: 1.28 95%CI 0.94-1.74; P = .12), as well as in terms of urosepsis (group A: 2 [0.30%] and group B: 4 [0.26%]; P = 1.0).

CONCLUSION

In patients undergoing urologic surgical procedures who are receiving antimicrobial prophylaxis in accordance with European Association of Urology guidelines, the preoperative presence of AB in this study was not associated with a higher incidence of postoperative symptomatic UTI.

摘要

目的

评估在接受泌尿外科手术的患者中是否总是有必要检测无症状菌尿(AB)的存在,以及如果存在AB,是否用抗菌药物预防治疗。

材料与方法

本研究纳入了2008年12月至2013年10月在一家三级转诊泌尿外科中心接受泌尿外科手术的所有患者。所有患者均按照欧洲泌尿外科协会关于泌尿系统感染的指南接受抗菌药物预防。如果培养出≥10菌落形成单位/毫升,则诊断为AB。将患者分为两组:A组为术前有AB的患者,B组为无AB的患者。比较两组术后有症状性尿路感染(UTI)的数据。

结果

共有2201例患者被认为符合本研究条件并进行了分析;发现668例(30.4%)患者存在AB(A组),1533例(69.6%)患者没有AB(B组)。198例患者(8.9%)发生了微生物学证实的术后有症状性UTI。两组之间在术后有症状性UTI的总体发生率方面没有差异(A组:70例[10.4%],B组:128例[8.3%];比值比:1.28,95%置信区间0.94 - 1.74;P = 0.12),在尿脓毒症方面也没有差异(A组:2例[0.30%],B组:4例[0.26%];P = 1.0)。

结论

在按照欧洲泌尿外科协会指南接受抗菌药物预防的泌尿外科手术患者中,本研究中术前AB的存在与术后有症状性UTI的较高发生率无关。

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