Perepanova T S, Merinov D S, Kazachenko A V, Khazan P L, Malova Yu A
N.A. Lopatkin Research Institute of Urology and Interventional Radiology branch of the National Medical Research Radiological Center, Moscow, Russia.
Urologiia. 2020 Jun(3):26-33.
Given the increase in antibiotic resistance of uropathogens, one of the urgent problems is a development of optimal antimicrobial prophylaxis for surgical interventions, as well as an adequate regimen of antibiotic therapy after percutaneous nephrolithotomy (PCNL).
to determine an effective perioperative antimicrobial prophylaxis for PCNL in patients with kidney stones.
A total of 90 patients with staghorn or multiple large kidney stones who underwent PCNL were included in the study. Before PCNL, urine culture was performed in all patients in order to determine the sensitivity not only to antibiotics, but also to bacteriophages. In addition, urine was taken for additional microbiological studies after the puncture of the collecting system, as well as on the 3rd and 7th day after PCNL. All patients were divided into three groups of 30 patients depending on the regimen of perioperative prophylaxis. In group 1, patients were prescribed ciprofloxacin 1000 mg i.v. intraoperatively, then 1000 mg i.v. q.d. for 3-5 days. In the group 2, patients received one dose of cefotaxime + sulbactam (1.0 g + 0.5 g) 2 hours before PCNL i.m. In the group 3, a polyvalent pyobacteriophage purified was given orally 1 hour before PCNL in a dose of 40 ml and the same dose was used t.i.d. for 3-5 days postoperatively.
In all three groups of patients, the following infectious complications were evaluated: acute pyelonephritis, systemic inflammatory response syndrome (SIRS) and urosepsis. There were no serious infectious and inflammatory complications in the early postoperative period among all patients. SIRS developed on days 1-3 after PCNL in 26.6%, 20% and 20% of patients in group 1, 2 and 3, respectively. However, by days 4-7 after PCNL, there was normalization of blood cells count (leukocytes, neutrophil band cells), temperature and general condition.
Different regimens of antimicrobial prophylaxis for PCNL have the same efficiency. The development of SIRS on days 1-3 after PCNL is correlated not only with the antimicrobial agents used and the route of their administration (intravenously, intramuscularly and orally). Most likely, the development of SIRS is more associated with surgical trauma.
鉴于尿路致病菌的抗生素耐药性增加，一个紧迫的问题是为手术干预制定最佳抗菌预防措施，以及经皮肾镜取石术（PCNL）后适当的抗生素治疗方案。
确定肾结石患者PCNL有效的围手术期抗菌预防措施。
本研究共纳入90例行PCNL的鹿角形或多发性大肾结石患者。PCNL术前，对所有患者进行尿培养，以确定其不仅对抗生素，而且对噬菌体的敏感性。此外，在穿刺集合系统后以及PCNL术后第3天和第7天采集尿液进行额外的微生物学研究。根据围手术期预防方案，将所有患者分为三组，每组30例。第1组患者术中静脉注射环丙沙星1000mg，然后每天静脉注射1000mg，共3 - 5天。第2组患者在PCNL前2小时肌肉注射一剂头孢噻肟+舒巴坦（1.0g + 0.5g）。第3组患者在PCNL前1小时口服一剂纯化的多价化脓性噬菌体，剂量为40ml，术后3 - 5天每天服用相同剂量三次。
在所有三组患者中，评估了以下感染并发症：急性肾盂肾炎、全身炎症反应综合征（SIRS）和尿脓毒症。所有患者术后早期均未出现严重的感染和炎症并发症。PCNL术后第1 - 3天，第1组、第2组和第3组分别有26.6%、20%和20%的患者发生SIRS。然而，在PCNL术后第4 - 7天，血细胞计数（白细胞、中性粒细胞杆状核细胞）、体温和一般状况恢复正常。
PCNL不同的抗菌预防方案具有相同的效果。PCNL术后第1 - 3天SIRS的发生不仅与所用抗菌药物及其给药途径（静脉内、肌肉内和口服）有关。很可能，SIRS的发生更多与手术创伤有关。
