Naboka Yu L, Kogan M I, Gudima I A, Mitusova E V, Bedzhanyan S K, Chernitskaya M L
RostSMU of Minzdrav of Russia, Rostov on Don, Russia.
Urologiia. 2018 Oct(4):44-48.
The generally accepted standard of antibiotic therapy aimed at causative agent does not exclude the risk of acute obstructive pyelonephritis (AOP) to become chronic after the end of antibiotic therapy, resulting in a high incidence of relapses. To assess the outcomes of the AOP, we undertook a prospective clinical trial. MATERIALS AND METHODS: The study comprised 51 consistently selected patients (12 men and 39 women) with AOP occurred as a result of unilateral ureteric calculus obstruction. Inclusion criteria for the study were as follows: no history of urological diseases, including urinary stones; the first presentation to the urologist with AOP; the level of the bladder bacteriuria before the drainage of the obstructed kidney more or equal 103 CFU/ml. Bladder urine samples were collected for bacteriological examination by catheterization. At one, 3 and 6 months after completion of the treatment of AOP, the patients underwent a general clinical examination, and midstream specimens of urine were collected from the patients for bacteriological analysis to control leukocyturia and bacteriuria. RESULTS: Eradication of causative uropathogens from urine occurred within 6 months in 96.1% of patients, and at that point, leukocyturia persisted in 23.5% of the patients. The decrease in detecting uropathogens in the urine was accompanied by an increase in the frequency of the presence in the urine of other aerobes and anaerobes, i.e., no sterile urine cultures were obtained from any patient. The rates of eradication of uropathogens were associated with the patients age, the duration of the pre-hospital stage of AOP, and the complicated course of AOP.
针对病原体的抗生素治疗普遍接受的标准并不能排除急性梗阻性肾盂肾炎(AOP)在抗生素治疗结束后转为慢性的风险,从而导致高复发率。为了评估AOP的治疗结果,我们进行了一项前瞻性临床试验。材料与方法:该研究纳入了51例经连续选择的患者(12例男性和39例女性),他们因单侧输尿管结石梗阻而发生AOP。该研究的纳入标准如下:无泌尿系统疾病史,包括尿路结石;首次因AOP就诊于泌尿外科医生;梗阻性肾脏引流前膀胱菌尿水平≥10³CFU/ml。通过导尿收集膀胱尿液样本进行细菌学检查。在AOP治疗完成后的1个月、3个月和6个月,对患者进行全面的临床检查,并收集患者的中段尿样本进行细菌学分析,以控制白细胞尿和菌尿。结果:96.1%的患者在6个月内尿液中的致病尿路病原体被清除,此时,23.5%的患者仍存在白细胞尿。尿液中致病病原体检测率的下降伴随着尿液中其他需氧菌和厌氧菌出现频率的增加,即没有任何患者获得无菌尿培养结果。致病病原体的清除率与患者年龄、AOP院前阶段的持续时间以及AOP的复杂病程有关。