Department of Urology, Minimally Invasive Surgery Center, Guangzhou Institute of Urology, Guangdong Key Laboratory of Urology, Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1#, Haizhu District, Guangzhou, 510230, Guangdong, China.
World J Urol. 2021 Jan;39(1):239-246. doi: 10.1007/s00345-020-03155-6. Epub 2020 Mar 20.
Extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) is one of the most frightening multidrug-resistant bacteria that usually causes sepsis. Herein we explored the benefits of nephrostomy drainage prior to percutaneous nephrolithotomy (PCNL) on infection outcomes in patients with ESBL-EC.
Between June 2016 and April 2019, 43 consecutive patients with ESBL-EC who received nephrostomy drainage for > 24 h prior to PCNL were retrospectively evaluated as group 1. 86 patients were randomly selected from patients with ESBL-EC who received concurrent percutaneous access during PCNL as group 2. The postoperative infection complications were compared.
Although the total infection complications were not statistically different (11.6% vs. 25.6%, p = 0.066), the severity seemed to be worse among group 2 subjects. Severe infections, including urosepsis (4.7% vs.13.9%) and septic shock (2.3% vs 4.6%), were observed at twice or greater rates in group 2. Blood transfusions were also more frequent (2.3% vs. 13.9%, p = 0.039). Multivariate analysis demonstrated that preoperative drainage was an independent risk factor for postoperative infection events (OR 2.31 CI 1.14-3.48, p = 0.017). Subgroup analyses indicated that preoperative drainage may largely reduce the incidence of urosepsis in patients with hydronephrosis or without receiving preoperative carbapenem therapy.
Because of the high rate of severe infection after PCNL in patients with ESBL‑positive E. coli, preoperative nephrostomy drainage for > 24 h is an effective measure to reduce the risk of severe infection complications, especially in patients with hydronephrosis or those without preoperative carbapenem therapy.
产超广谱β-内酰胺酶的大肠埃希菌（ESBL-EC）是最令人恐惧的多重耐药菌之一，通常会引起败血症。在此，我们探讨了在接受经皮肾镜碎石术（PCNL）之前行肾造瘘引流对 ESBL-EC 患者感染结局的影响。
回顾性分析 2016 年 6 月至 2019 年 4 月间 43 例接受肾造瘘引流>24 h 后行 PCNL 的 ESBL-EC 患者（组 1）。随机选取同期行 PCNL 同期经皮肾通道接受治疗的 86 例 ESBL-EC 患者作为组 2。比较两组患者术后感染并发症。
虽然总感染并发症无统计学差异（11.6% vs. 25.6%，p=0.066），但组 2 患者的严重感染似乎更严重。组 2 患者中严重感染（包括菌血症 4.7% vs. 13.9%和感染性休克 2.3% vs. 4.6%）的发生率更高。输血也更为频繁（2.3% vs. 13.9%，p=0.039）。多因素分析显示，术前引流是术后感染事件的独立危险因素（OR 2.31，95%CI 1.14-3.48，p=0.017）。亚组分析表明，术前引流可能会大大降低肾积水或未接受术前碳青霉烯类治疗的患者发生菌血症的发生率。
由于 ESBL-阳性大肠埃希菌患者行 PCNL 后严重感染发生率较高，术前行>24 h 肾造瘘引流是降低严重感染并发症风险的有效措施，尤其适用于肾积水或未接受术前碳青霉烯类治疗的患者。
