Columbia University, Premed Postbac program, New York, NY, United States of America.
NYMC, Metropolitan Hospital Center, Department of Emergency Medicine, New York, NY, United States of America.
Am J Emerg Med. 2019 Oct;37(10):1855-1859. doi: 10.1016/j.ajem.2018.12.046. Epub 2018 Dec 24.
Kidney stone related complaints in the Emergency Department (ED) are common. Current guidelines recommend antibiotic therapy for infected obstructive stones and stone removal in a timely fashion, but there is no clear recommendation for prophylactic antibiotic use for bacteriuria or pyuria in the setting of obstructive ureteral stones.
The aim of this study is to evaluate the current management of patients with obstructive ureteral stones in a single ED with emphasis on urine tests and antibiotics use.
The picture archiving and communication system (PACS) was used to filter the list of patients who received a computed tomography (CT) scan of the abdomen and pelvis that positively identified obstructive ureteral stones. Demographics and clinical data were also recorded and analyzed.
Of the patients discharged, 278 patients did not receive antibiotics in the ED or a prescription. Of these, 8 patients had positive culture, 4 patients followed up, and one developed and was treated for a urinary-tract infection. One hundred ninety two patients were not given antibiotics in the ED but received an antibiotics prescription, and 4 patients had positive cultures grow. Two followed up and had no infection-related complications. Fourteen patients were discharged without a prescription after receiving a single dose of antibiotics in the ED, with no positive urine cultures and 9 patients following up without complication.
Antibiotics were given at the discretion of the provider without clear pattern. A high rate of infectious complication did not occur in the followed up patient group.
在急诊科（ED），肾结石相关的投诉很常见。目前的指南建议对感染性梗阻性结石进行抗生素治疗，并及时进行结石清除，但对于梗阻性输尿管结石患者的菌尿或脓尿，目前没有明确推荐预防性使用抗生素。
本研究旨在评估单一急诊科中梗阻性输尿管结石患者的当前治疗方法，重点是尿液检查和抗生素的使用。
使用图像存档和通信系统（PACS）筛选接受腹部和骨盆 CT 扫描的患者名单，这些患者的 CT 扫描明确诊断为梗阻性输尿管结石。还记录和分析了患者的人口统计学和临床数据。
在出院患者中，有 278 名患者在急诊科或未开处方使用抗生素。其中 8 例有阳性培养，4 例患者随访，1 例发生并接受尿路感染治疗。192 名患者在急诊科未使用抗生素，但开了抗生素处方，其中 4 例有阳性培养。2 例患者随访，无感染相关并发症。14 名患者在急诊科接受单次抗生素治疗后未开处方出院，无阳性尿液培养，9 名患者随访无并发症。
抗生素的使用是根据医生的判断，没有明确的模式。在随访患者组中，未发生高感染并发症发生率。
