[尿动力学中的抗生素预防：采用正式共识方法的临床实践指南]
[Antibiotic prophylaxis in urodynamics: Clinical practice guidelines using a formal consensus method].
作者信息
Egrot C, Dinh A, Amarenco G, Bernard L, Birgand G, Bruyère F, Chartier-Kastler E, Cosson M, Deffieux X, Denys P, Etienne M, Fatton B, Fritel X, Gamé X, Lawrence C, Lenormand L, Lepelletier D, Lucet J-C, Marit Ducamp E, Pulcini C, Robain G, Senneville E, de Sèze M, Sotto A, Zahar J-R, Caron F, Hermieu J-F
机构信息
Service d'urologie, université Paris-7, hôpital Bichat Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
Unité de maladies infectieuses, UVSQ, hôpital Raymond-Poincaré, AP-HP, 92380 Garches, France.
出版信息
Prog Urol. 2018 Dec;28(17):943-952. doi: 10.1016/j.purol.2018.10.001. Epub 2018 Nov 27.
OBJECTIVE
The aim of this work was to issue clinical practice guidelines on antibiotic prophylaxis in urodynamics (urodynamic studies, UDS).
MATERIALS AND METHODS
Clinical practice guidelines were provided using a formal consensus method. Guidelines proposals were drew up by a multidisciplinary experts group (pilot group = steering group), then rated by a panel of 12 experts (rating group) using a formal consensus method, and then peer reviewed by a reviewing/reading group of experts (different from the rating group).
RESULTS
Urine (bacterial) culture with antimicrobial susceptibility testing is recommended for all patients before UDS (strong agreement). In patients with no neurologic disease, the risk factors for tract urinary infection (UTI) after UDS are age > 70 years, recurrent UTI, and post-void residual volume > 100ml. In patients with neurologic disease, the risk factors for UTI after UDS are recurrent UTI, vesicoureteral reflux, and intermicturition pressure > 40cmHO. If the urine culture is negative before UDS and there is no risk factor for UTI, antibiotic prophylaxis is not recommended (Strong agreement). If the urine culture is negative before UDS, but there are one or more risk factors for UTI, antibiotic prophylaxis is optional. If antibiotic prophylaxis is initiated, a single oral dose (3g) of fosfomycin-tromethamine two hours before UDS is recommended (Strong agreement). If there is bacterial colonization on UCB before UDS, antibiotic therapy is optional (Undecided). If prescribed, it should be adapted to the antimicrobial susceptibility of the identified bacterium or bacteria, started the day before and stopped after UDS (except for fosfomycin-tromethamine: a single dose the day before UDS is necessary and sufficient) (Strong agreement). In the event of UTI before UDS, the UTI should be treated and UDS postponed (Strong agreement). The proposed recommendations should not be changed for patients with a hip or knee replacement (Strong agreement). No antibiotic prophylaxis of bacterial endocarditis is necessary, including in high-risk patients with valvular heart disease (Strong agreement).
CONCLUSION
These new guidelines should help to harmonize clinical practice and limit exposure to antibiotics.
LEVEL OF EVIDENCE
目的
本研究旨在发布关于尿动力学检查（尿动力学研究，UDS）中抗生素预防的临床实践指南。
材料与方法
采用正式的共识方法制定临床实践指南。指南建议由多学科专家组（试点组 = 指导组）起草，然后由12名专家组成的小组（评级组）使用正式的共识方法进行评级，随后由专家评审/阅读组（与评级组不同）进行同行评审。
结果
建议在所有患者进行尿动力学检查前进行尿液（细菌）培养及药敏试验（强烈共识）。在无神经疾病的患者中，尿动力学检查后发生泌尿系统感染（UTI）的危险因素为年龄 > 70岁、复发性UTI和排尿后残余尿量 > 100ml。在有神经疾病的患者中，尿动力学检查后发生UTI的危险因素为复发性UTI、膀胱输尿管反流和排尿间期压力 > 40cmH₂O。如果尿动力学检查前尿培养阴性且无UTI危险因素，则不建议预防性使用抗生素（强烈共识）。如果尿动力学检查前尿培养阴性，但存在一个或多个UTI危险因素，则预防性使用抗生素为可选项。如果开始预防性使用抗生素，建议在尿动力学检查前两小时口服单剂量（3g）磷霉素氨丁三醇（强烈共识）。如果尿动力学检查前尿培养有细菌定植，抗生素治疗为可选项（未决）。如果开具抗生素，应根据鉴定出的一种或多种细菌的药敏情况进行调整，在尿动力学检查前一天开始用药，检查后停药（磷霉素氨丁三醇除外：在尿动力学检查前一天单剂量给药即可）（强烈共识）。如果在尿动力学检查前发生UTI，应治疗UTI并推迟尿动力学检查（强烈共识）。对于髋关节或膝关节置换患者，建议不变（强烈共识）。无需预防性使用抗生素预防细菌性心内膜炎，包括患有瓣膜性心脏病的高危患者（强烈共识）。
结论
这些新指南应有助于统一临床实践并减少抗生素暴露。
证据级别
4级。
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