Department of Urology, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK.
Department of Microbiology, London North West University Healthcare NHS Trust, Watford Road, Harrow, London, HA1 3UJ, UK.
World J Urol. 2020 Jan;38(1):45-55. doi: 10.1007/s00345-019-02663-4. Epub 2019 Feb 7.
There are few published reviews that have assessed the clinical utility of renal urine cultures following percutaneous nephrostomy (PCN). In this systematic review, we evaluated the published evidence of the clinical utility of nephrostomy urine cultures in the light of emerging antimicrobial resistance and need for stewardship.
We performed a systematic literature search and review for evidence on the utility and role of nephrostomy urine cultures, using Medline, Embase and PubMed. We looked for evidence to assess whether there is any utility in collecting renal urine for culture at the time of percutaneous nephrostomy (PCN) and if the culture results of nephrostomy urine and bladder urine are different. We studied outcomes of treatment based on nephrostomy culture results. We also examined the role of PCN cultures at the time of routine nephrostomy exchange. Finally, we assessed if doing a PCN leads to infection or pyelonephritis.
From 94 studies initially identified, we finally selected two randomised clinical trials (RCT), six original articles and five detailed conference abstracts for the review. These studies suggest that PCN urine cultures are overall useful in clinical practice. They are useful in selecting appropriate antimicrobial treatment for urosepsis following upper urinary obstruction. There does not appear to be any advantage in performing PCN cultures at routine nephrostomy exchanges. Occasionally, PCN itself can lead to subsequent urosepsis.
Nephrostomy urine cultures have utility in clinical practice and can help support treatment and antimicrobial stewardship.
经皮肾造瘘术（PCN）后，对肾尿培养的临床实用性进行评估的文献很少。在本系统评价中，我们根据新出现的抗菌药物耐药性和管理需求，评估了经皮肾造瘘术尿液培养的临床实用性的现有证据。
我们使用 Medline、Embase 和 PubMed 进行了系统的文献检索和综述，以寻找关于经皮肾造瘘术时收集肾尿液进行培养的实用性和作用的证据，并评估在经皮肾造瘘术时收集肾尿液进行培养是否有任何作用，以及经皮肾造瘘术尿液和膀胱尿液的培养结果是否不同。我们根据经皮肾造瘘术培养结果研究了治疗结果。我们还研究了常规经皮肾造瘘术更换时经皮肾造瘘术培养的作用。最后，我们评估了经皮肾造瘘术是否会导致感染或肾盂肾炎。
从最初确定的 94 项研究中，我们最终选择了两项随机临床试验（RCT）、六篇原始文章和五篇详细的会议摘要进行综述。这些研究表明，经皮肾造瘘术尿液培养在临床实践中总体上是有用的。它们可用于选择上尿路梗阻后脓毒症的合适抗菌治疗。在常规经皮肾造瘘术更换时进行经皮肾造瘘术培养似乎没有任何优势。偶尔，经皮肾造瘘术本身可导致随后发生脓毒症。
经皮肾造瘘术尿液培养在临床实践中有一定的作用，可以帮助支持治疗和抗菌药物管理。
