Department of Urology, Guangdong Key Laboratory of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Department of Urology, The People's Hospital of Qingyuan City, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, China.
BJU Int. 2019 Jun;123(6):1041-1047. doi: 10.1111/bju.14484. Epub 2018 Aug 9.
To obtain more accurate and rapid predictors of postoperative infections following percutaneous nephrolithotomy (PCNL) in patients with complex kidney stones, and provide evidence for early prevention and treatment of postoperative infections.
A total of 802 patients with complex kidney stones who underwent PCNL, from September 2016 to September 2017, were recruited. Urine tests, urine cultures (UCs) and stone cultures (SCs) were performed, and the perioperative data were prospectively recorded.
In all, 19 (2.4%) patients developed postoperative urosepsis. A multivariate logistic regression analysis revealed that an operating time of ≥100 min, urine test results with both positive urine white blood cells (WBC+) and positive urine nitrite (WBC+NIT+), positive UCs (UC+), and positive SCs (SC+) were independent risk factors of urosepsis. The incidence of postoperative urosepsis was higher in patients with WBC+NIT+ (10%) or patients with both UC+ and SC+ (UC+SC+; 8.3%) than in patients with negative urine test results or negative cultures (P < 0.01). Preoperative WBC+NIT+ was predictive of UC+SC+, with an accuracy of >90%. The main pathogens found in kidney stones were Escherichia coli (44%), Proteus mirabilis (14%) and Staphylococcus (7.4%); whilst the main pathogens found in urine were E. coli (54%), Enterococcus (9.4%) and P. mirabilis (7.6%). The incidence of E. coli was more frequent in the group with urosepsis than in the group without urosepsis (P < 0.05).
WBC+NIT+ in preoperative urine tests could be considered as an early and rapid predictor of UC+SC+ and postoperative urosepsis. Urosepsis following PCNL was strongly associated with E. coli infections in patients with complex kidney stones.
为了更准确、快速地预测复杂肾结石患者经皮肾镜碎石取石术后（PCNL）感染，为术后感染的早期预防和治疗提供依据。
选取 2016 年 9 月至 2017 年 9 月行 PCNL 的 802 例复杂肾结石患者，进行尿检验、尿培养（UC）和结石培养（SC），并前瞻性记录围手术期数据。
共有 19 例（2.4%）患者发生术后尿脓毒症。多因素 logistic 回归分析显示，手术时间≥100min、尿白细胞阳性（WBC+）且尿亚硝酸盐阳性（WBC+NIT+）、UC+、SC+是尿脓毒症的独立危险因素。WBC+NIT+（10%）或 UC+和 SC+（UC+SC+；8.3%）患者的术后尿脓毒症发生率高于尿检验或培养阴性患者（P<0.01）。术前 WBC+NIT+预测 UC+SC+的准确率>90%。肾结石的主要病原体为大肠埃希菌（44%）、奇异变形杆菌（14%）和葡萄球菌（7.4%）；尿液的主要病原体为大肠埃希菌（54%）、肠球菌（9.4%）和奇异变形杆菌（7.6%）。脓毒症组的大肠埃希菌发生率高于非脓毒症组（P<0.05）。
术前尿检验中 WBC+NIT+可作为 UC+SC+和术后尿脓毒症的早期、快速预测指标。复杂肾结石患者 PCNL 后尿脓毒症与大肠埃希菌感染密切相关。
