Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China; Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China; Guangzhou Institute of Urology, Guangzhou, Guangdong, China.
Division of Urology, Department of Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
Int J Infect Dis. 2020 Aug;97:162-166. doi: 10.1016/j.ijid.2020.05.095. Epub 2020 Jun 2.
To assess the relevance of urine test (UT), urine culture (UC) and stone culture (SC) for postoperative infections and to investigate the optimal perioperative antibiotic treatment strategy in association with percutaneous nephrolithotomy (PCNL) in patients with renal calculi.
Between September 2016 and September 2018 1,060 patients treated with PCNL were included in the study. The results of UT, UC and SC were reviewed. The details of perioperatively administered antibiotics and postoperative infections were recorded.
A positive UT was associated with an increased incidence of infection; this was also the case in patients with negative UC (p < 0.05). There was no significant difference in incidence of infection between patients who were given a single dose of antibiotics compared with those given multiple doses when UC was negative, whether UT was positive or negative (all p > 0.05). The incidence of infection was decreased when pre-operative antibiotics were administered according to the sensitivity pattern based on UC (p < 0.05). This outcome was particularly evident when the treatment duration exceeded 7 days (p < 0.05). A positive SC was associated with increased incidence of infection, even if the patient had a negative UC and UT (p < 0.05). The incidence of infection was significantly decreased when antibiotic treatment was administered based on the results of SC (p < 0.05).
Pre-operative prophylaxis with a single-dose antibiotic was sufficient in patients with negative UC, whether UT was positive or negative. Pre-operative treatment with antibiotics according to the bacterial sensitivity pattern should be administered for ≥7 days in patients with positive UC. The postoperative antibiotic treatment strategy should be tailored according to the SC results.
评估尿检测（UT）、尿培养（UC）和结石培养（SC）在肾结石患者经皮肾镜碎石取石术（PCNL）后感染中的相关性，并探讨与 PCNL 相关的最佳围手术期抗生素治疗策略。
本研究纳入 2016 年 9 月至 2018 年 9 月期间接受 PCNL 治疗的 1060 例患者。回顾 UT、UC 和 SC 的结果。记录围手术期应用抗生素和术后感染的详细情况。
UT 阳性与感染发生率增加相关；UC 阴性患者也如此（p<0.05）。UC 阴性时，与单次剂量组相比，多次剂量组的抗生素治疗，无论 UT 阳性或阴性，感染发生率均无显著差异（均 p>0.05）。术前根据 UC 药敏模式应用抗生素（p<0.05）可降低感染发生率。治疗时间超过 7 天时，效果更明显（p<0.05）。SC 阳性与感染发生率增加相关，即使 UC 和 UT 均为阴性（p<0.05）。根据 SC 结果应用抗生素治疗可显著降低感染发生率（p<0.05）。
UC 阴性患者无论 UT 阳性或阴性，术前应用单剂量抗生素预防即可。UC 阳性患者应根据细菌药敏模式进行术前治疗，且治疗时间至少应持续 7 天。术后抗生素治疗策略应根据 SC 结果进行调整。
