Urology department, Clinic Of High Medical Techonologies n.a. N.I. Pirogov, Saint-Petersburg State University, Saint-Petersburg, Russia.
Urol J. 2020 Apr 19;17(6):587-591. doi: 10.22037/uj.v0i0.5561.
To determine the efficacy and safety of PCNL in patients with positive urine culture without an any other risk factors prior to surgery, and to define an optimal pre-operative antibiotic regimen for these patients.
The study included 269 consecutive PCNL cases. These cases were divided into 2 groups according pre-operative urine culture results: sterile (group 1, n=166) and positive (group 2, n=103). Patients with risk factors linked to infection complications were excluded from study. All patients underwent PCNL in the prone position. In group 1, the antibiotic regimen included parenteral injection 30 minutes prior to operation and for 3 days after surgery. Group 2 was given antibiotics 24 hours before PCNL as well as 30 minutes before PCNL and then for 3 days following surgery. On the first day after the operation low dose CT and common blood count were performed on all patients to determine residuals, hematomas, blood loss, and inflammatory markers. Results: Mean age, stone size, failed ESWL, and prior nephrostomy tube insertion were higher in group 2. Although rate of pre-stented patients was equal in groups. No significant differences were observed between group 1 and 2 in regard to operative time (74,3±26,9 vs 70,2±26,5 min, P=.52), length of stay (3,9±1,2 vs 3,8±1,6 days, P=.24), SIRS (6,0% vs 7,8% patients, P=.07), and leukocyte levels exceeding 10109 (77 (46,4%) vs 49 (47,6%) P=.11). Moreover, there was no sepsis or hemotransfusion in either group. Stone-free rates were also similar (78,9% vs 77,7%, P=.35).
24-hours continuous antibiotic administration before the operation (paying respect to specific resistance bacterial features) can be considered as alternative to 1-week treatment and allow to perform PCNL with sufficient safety in selected patients. Infected urine is not an independent risk factor of post-operative infections complications after PCNL in low risk patients with kidney stones.
确定术前尿液培养阳性且无其他任何危险因素的患者行 PCNL 的疗效和安全性，并为这些患者确定最佳的术前抗生素治疗方案。
本研究纳入了 269 例连续接受 PCNL 的患者。根据术前尿液培养结果，这些患者被分为两组：无菌组（n=166）和阳性组（n=103）。排除有感染并发症相关危险因素的患者。所有患者均取俯卧位行 PCNL。在无菌组中，抗生素方案包括术前 30 分钟静脉注射，并在术后 3 天内使用。阳性组患者在 PCNL 前 24 小时内以及 PCNL 前 30 分钟内使用抗生素，然后在术后 3 天内使用。所有患者在术后第一天进行低剂量 CT 和常规血常规检查，以确定残石、血肿、失血和炎症标志物。
阳性组患者的平均年龄、结石大小、ESWL 失败和先前的肾造瘘管插入率均较高。虽然两组患者中术前留置支架的比例相同，但组间在手术时间（74.3±26.9 分钟 vs 70.2±26.5 分钟，P=.52）、住院时间（3.9±1.2 天 vs 3.8±1.6 天，P=.24）、SIRS（6.0% vs 7.8%的患者，P=.07）和白细胞计数超过 10109（77（46.4%） vs 49（47.6%），P=.11）方面无显著差异。此外，两组均未发生脓毒症或输血。结石清除率也相似（78.9% vs 77.7%，P=.35）。
在术前 24 小时内连续给予抗生素（尊重特定的耐药菌特征）可以替代 1 周的治疗方案，并允许在选定的患者中安全地进行 PCNL。对于低风险肾结石患者，术前尿液培养阳性并非 PCNL 后感染并发症的独立危险因素。
