Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1460, Houston, TX, 77030, USA.
Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Infection. 2019 Apr;47(2):239-245. doi: 10.1007/s15010-018-1245-y. Epub 2018 Nov 7.
Percutaneous nephrostomy (PCN) catheters are mainly indicated for urinary tract obstructions. Unfortunately, the rate for infection and recurrence remains elevated. Our objective was to identify the risk factors leading to recurrent PCN-related infections (PCNI) in cancer patients.
We retrospectively reviewed 571 patients who underwent initial PCN catheter placement at our institution. Of these, we identified patients with a definite PCNI and catheter exchange, with a minimum 30-day follow-up. We defined PCNI as presence of a urine culture positive for bacteria (≥ 104 CFU/mL) plus symptoms of urinary tract infection. A PCNI was considered recurrent if the same organism was isolated. Antibiotics were considered concordant if they were active against all identified organisms.
A total of 81 patients (14%) developed an initial PCNI. Of 47 patients with 30-day follow-up, 10 patients (21%) were identified as having a recurrent PCNI. In terms of demographic characteristics, clinical manifestations, and microbiological data, there was no statistically significant difference between the recurrent and non-recurrent groups. However, in multivariate logistic regression analysis, two factors were independently associated with a decrease in recurrent PCNI: concordant antibiotic use (OR 0.04; p = 0.008) and PCN catheter exchange within 4 days of infection (OR 0.1; p = 0.048).
To decrease the high rate of recurrent infections, associated costs, and potential delay in further chemotherapy, we recommend that once antimicrobial susceptibility test results are available and the patient is known to be receiving concordant antimicrobials, clinicians proceed with immediate PCN catheter exchange, ideally within the first 4 days of the infection.
经皮肾造瘘术（PCN）导管主要用于治疗尿路梗阻。然而，感染和复发的发生率仍然居高不下。我们的目的是确定导致癌症患者 PCN 相关感染（PCNI）复发的危险因素。
我们回顾性分析了在我院行初次 PCN 导管置入的 571 例患者。在这些患者中，我们确定了有明确 PCNI 并进行了导管更换的患者，且随访时间至少为 30 天。我们将 PCNI 定义为尿液培养细菌阳性（≥104 CFU/mL）且有尿路感染症状。如果同一病原体被分离出来，则认为 PCNI 是复发性的。如果抗生素对所有鉴定出的病原体均有效，则认为抗生素是一致的。
共有 81 例患者（14%）发生了初次 PCNI。在 47 例有 30 天随访的患者中，有 10 例（21%）被确定为发生了复发性 PCNI。在人口统计学特征、临床表现和微生物学数据方面，复发性和非复发性组之间没有统计学上的显著差异。然而，在多变量逻辑回归分析中，有两个因素与复发性 PCNI 的降低独立相关：一致的抗生素使用（OR 0.04；p=0.008）和在感染后 4 天内更换 PCN 导管（OR 0.1；p=0.048）。
为了降低高复发感染率、相关成本和潜在的化疗延迟，我们建议一旦获得抗菌药物敏感性试验结果，并且患者已知正在接受一致的抗菌药物治疗，临床医生应尽快进行 PCN 导管更换，理想情况下在感染后的前 4 天内进行。
