Department of Surgery, Austin Health, University of Melbourne, Melbourne, Australia.
Department of Urology, Austin Health, Heidelberg, Victoria, Australia.
World J Urol. 2020 Jun;38(6):1413-1422. doi: 10.1007/s00345-019-02964-8. Epub 2019 Sep 27.
Urinary diversion procedures frequently result in bacterial colonisation. There is an increased incidence of developing urinary tract infections (UTIs) in this patient population. Current guidelines, however, recommend against treating this colonisation. This systematic review aimed to determine when and how to test, monitor, and treat bacteriuria in patients with urinary diversion.
A systematic search strategy was conducted based on keywords "urinary diversion" and "bacteriuria", on MEDLINE, Embase, and Google Scholar. Articles were screened and included only if they reported on (i) testing methods for bacteriuria, (ii) surveillance of bacteriuria over time, or (iii) when and how to treat bacteriuria. Results were summarised and reported using a narrative synthesis.
Altogether, 26 studies were included in this review. Inconsistencies were noted in the definitions of bacteriuria, with most studies reporting bacteriuria as > 10 cfu/mL (8/17 studies). Bacteriuria prevalence varied greatly (range 9.1-100%). Monitoring bacteriuria over time may help detect a reduction in bacteriuria, as demonstrated in three studies (follow-up range 5-18 months; sample size 18-56). The link between preceding bacteriuria and subsequent UTIs has not been fully explored yet. Short-term antimicrobial therapy may be useful in the immediate post-operative setting; however, long-term prophylactic treatment is ineffective in preventing bacteriuria.
We recommend consistent reporting of bacteriuria definitions, the benefits of monitoring bacteriuria over time, and use of short-term antimicrobial therapy; bacteriuria should not be treated with long-term therapy.
尿路分流术常导致细菌定植。在这类患者人群中，尿路感染（UTI）的发病率增加。然而，目前的指南建议不要针对这种定植进行治疗。本系统评价旨在确定何时以及如何对尿路分流患者进行尿细菌培养检测、监测和治疗。
基于“尿路分流”和“菌尿”的关键词，我们进行了系统的检索策略，检索了 MEDLINE、Embase 和 Google Scholar。仅当文章报告了（i）菌尿的检测方法，（ii）随时间监测菌尿，或（iii）何时以及如何治疗菌尿时，才对其进行筛选和纳入。结果使用叙述性综合进行总结和报告。
本综述共纳入了 26 项研究。菌尿的定义存在不一致性，大多数研究将菌尿报告为>10cfu/mL（17 项研究中的 8 项）。菌尿的患病率差异很大（范围 9.1-100%）。对菌尿随时间的监测可能有助于检测菌尿减少，这在三项研究中得到了证明（随访时间 5-18 个月；样本量 18-56）。菌尿与随后的 UTI 之间的关系尚未得到充分探讨。短期抗菌治疗在术后即刻可能有用；然而，长期预防性治疗并不能预防菌尿。
我们建议一致报告菌尿定义，监测菌尿随时间的变化的益处，并使用短期抗菌治疗；不应使用长期治疗来治疗菌尿。
