Vallée M, Cattoir V, Malavaud S, Sotto A, Cariou G, Arnaud P, Bugel H, Coloby P, Chartier-Kastler E, Bruyère F
Service d'urologie et de transplantations rénales, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France.
Service de bactériologie-hygiène hospitalière, CHU de Rennes, 2, rue Henri Le Guilloux, 35033 Rennes cedex 9, France.
Prog Urol. 2019 Apr;29(5):253-262. doi: 10.1016/j.purol.2019.02.010. Epub 2019 Apr 5.
The aim was to assess the risk of postoperative infections in patients with preoperative polymicrobial urine culture and to provide the urologist with practices to minimise the risk of infection in these clinical situations.
A systematic literature review was carried. All national and international recommendations have been reviewed. Data collection has been performed from the Cochrane, LILACS and the Medline database. 31 publications were selected for inclusion.
Risk of infection in patients without ureteral stents or urinary catheters with previous polymicrobial urine culture is low. In the absence of leukocyturia, the urine sample can be considered as sterile. With ureteral stents or urinary catheters, the colonisation by biofilm ranges from 4 to 100% depending on the duration and ureteral stents or urinary catheters type. Urine culture is positive 24 to 45% of the time when ureteral stents or urinary catheters are known to be colonised. The post-operative risk of infection in endo-urological surgery in a patient with ureteral stents or urinary catheters is estimated around 8 to 11% depending on the type of surgery. A retrospective study reports a postoperative infections rate of 18.5% in photo selective vaporization of the prostate with preoperative polymicrobial urine culture.
Scientific data are limited but for patients without ureteral stents or urinary catheters, in the absence of leukocyturia, the polymicrobial urine culture can be considered as negative. Considering a preoperative polymicrobial urine culture as sterile in patients with colonised ureteral stents or urinary catheters is at risk of neglecting a high risk of postoperative infections or sepsis even in case of perioperative antibiotic prophylaxis. It should not always be considered sterile and therefore, a perioperative antibiotic therapy could be an acceptable option.
目的是评估术前尿培养为多种微生物感染的患者术后感染的风险，并为泌尿外科医生提供在这些临床情况下降低感染风险的措施。
进行了一项系统的文献综述。对所有国内和国际推荐进行了审查。从Cochrane、LILACS和Medline数据库收集数据。选择了31篇出版物纳入研究。
既往有多种微生物尿培养结果的患者，在无输尿管支架或导尿管的情况下，感染风险较低。若无白细胞尿，可认为尿样无菌。对于有输尿管支架或导尿管的患者，生物膜定植率在4%至100%之间，具体取决于持续时间和输尿管支架或导尿管的类型。已知输尿管支架或导尿管有定植时，尿培养阳性率为24%至45%。对于有输尿管支架或导尿管的患者，根据手术类型不同，腔内泌尿外科手术的术后感染风险估计约为8%至11%。一项回顾性研究报告，术前有多种微生物尿培养结果的患者，经尿道前列腺选择性光汽化术后感染率为18.5%。
科学数据有限，但对于无输尿管支架或导尿管且无白细胞尿的患者，多种微生物尿培养结果可视为阴性。对于输尿管支架或导尿管有定植的患者，将术前多种微生物尿培养结果视为无菌，即使进行围手术期抗生素预防，也有忽视术后高感染风险或败血症的风险。不应总是将其视为无菌，因此围手术期抗生素治疗可能是一个可接受的选择。
