Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden.
Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden.
Scand J Urol. 2020 Apr;54(2):162-170. doi: 10.1080/21681805.2020.1740316. Epub 2020 Mar 25.
The incidence of urinary stones is increasing across the globe. Surgical treatment includes extracorporal shock-wave lithotripsy (ESWL), ureterolithotripsy (URS), percutaneous nephrolitotomy (PCNL) and rarely open surgery. This single center study describes complications to PCNL focusing on infections, bacterial growth/resistance and antibiotic prophylaxis/treatment. All patients treated for kidney stones with PCNL at Ängelholm Hospital in north-western Scania, Sweden from January 2009 to December 2015 were included. A dipstick test and a bacterial culture was made on all patients. Kidney stones were analysed for composition and cultured for bacteria. In total, 186 patients underwent PCNL, all receiving perioperative antibiotics. Thirty percent (56/186) had a positive urinary culture taken before surgery and 33.3% (62/186) had positive stone culture. The concordance between urinary and stone culture was 57.1%. Both positive stone and urinary culture increased the risk of complications after surgery ( = 0.002 and = 0.017, respectively). Complications occurred in 16% (30/186). Eight patients (4.3%) developed sepsis. The most common bacteria in urine were and both 20%. The most common stone-bacteria reported was (26%). This study has a total complication rate of 16%, approximately 10% of those are severe. The most common complication to PCNL was infection (60%), followed by bleeding (5.4%), reoperation (1.6%) and pain (0.5%). The high prevalence of might need to be considered, however the results should be validated in a larger cohort, possibly with a higher rate of antibiotic resistance, before a change of guidelines regarding prophylactic antibiotics could be proposed.
全球尿路结石的发病率正在上升。外科治疗包括体外冲击波碎石术（ESWL）、输尿管镜碎石术（URS）、经皮肾镜取石术（PCNL）和很少采用的开放性手术。本单中心研究描述了 PCNL 的并发症，重点关注感染、细菌生长/耐药性以及抗生素预防/治疗。所有在瑞典斯堪尼亚西北部的安格尔霍姆医院接受 PCNL 治疗的肾结石患者均纳入本研究。所有患者均进行了尿液试纸检测和细菌培养。对肾结石进行了成分分析和细菌培养。共有 186 例患者接受了 PCNL 治疗，所有患者均接受了围手术期抗生素治疗。30%（56/186）术前尿培养阳性，33.3%（62/186）结石培养阳性。尿培养和结石培养的一致性为 57.1%。阳性结石和尿培养均增加了术后并发症的风险（=0.002 和=0.017）。186 例患者中有 16%（30 例）发生了并发症。8 例（4.3%）患者发生脓毒症。尿液中最常见的细菌为 和 ，均占 20%。报告的最常见结石细菌为 （26%）。本研究总的并发症发生率为 16%，其中约 10%为严重并发症。PCNL 最常见的并发症是感染（60%），其次是出血（5.4%）、再次手术（1.6%）和疼痛（0.5%）。高流行的 可能需要考虑，然而，在提出预防性抗生素治疗指南的改变之前，需要在更大的队列中进行验证，可能需要考虑更高的抗生素耐药率。
