Berrondo Claudia, Ahn Jennifer J, Merguerian Paul A, Lendvay Thomas S, Shnorhavorian Margarett
Division of Pediatric Urology, Seattle Children's Hospital, Seattle, WA, USA; Department of Urology, University of Washington, Seattle, WA, USA; Division of Pediatric Urology, Children's Hospital and Medical Center, Omaha, NE, USA; Department of Surgery (Urological Surgery), University of Nebraska, Omaha, NE, USA.
Division of Pediatric Urology, Seattle Children's Hospital, Seattle, WA, USA; Department of Urology, University of Washington, Seattle, WA, USA.
J Pediatr Urol. 2021 Feb;17(1):103-109. doi: 10.1016/j.jpurol.2020.11.004. Epub 2020 Nov 8.
Recommendations for antibiotic prophylaxis prior to cystourethroscopy with manipulation are based on limited evidence and may not be applicable to procedures without tissue resection such as ureteral stent removal.
Our objectives were to investigate and compare practice patterns among adult and pediatric urologists on antibiotic prophylaxis for stent removal.
An online survey was distributed to members of the Endourological Society (EUS) and Societies for Pediatric Urology (SPU) including questions about provider demographics and practice patterns. Adult urologists were defined as EUS member respondents and pediatric urologists were defined as SPU member respondents. Comparisons were made using Pearson's Chi-Square analysis.
Of 2544 adult urologists surveyed, 258 (10%) completed the survey and of 714 pediatric urologists surveyed, 180 (25%) completed the survey (Table 1). Pediatric urologists report using antibiotic prophylaxis "most of the time" (i.e. ≥ 75% of the time) more often than adult urologist when removing stents by string or operating room cystoscopy but less often when removing stents by office cystoscopy. Pediatric urologists report using antibiotic prophylaxis "most of the time" more often than adult urologists after pyeloplasty, ureteroscopy and ureteral reimplantation. There is no difference in reported duration of prophylaxis between adult and pediatric urologists, with 64% giving a single dose. Pediatric urologists report obtaining a urine culture (UC) "most of the time" more often than adult urologists (32% vs 15%, p < 0.001), but there is no difference in reported use of antibiotic treatment by UC result. Sixty-four percent of survey respondents report giving patients with negative UC antibiotic treatment, and 93% of survey respondents report treating patients with asymptomatic bacteriuria (defined as patients with a positive urine culture but no symptoms) with antibiotics.
There is variation in reported practice among surveyed adult and pediatric urologists regarding antibiotic prophylaxis prior to stent removal. Overall, pediatric urologists report using antibiotic prophylaxis prior to stent removal more often than adult urologists.
This variation in practice combined with lack of evidence to support the use of antibiotic prophylaxis prior to ureteral stent removal underscores the need for additional research to guide the development of evidence-driven guidelines for both adult and pediatric patients.
对于伴有操作的膀胱尿道镜检查前抗生素预防的建议基于有限的证据，可能不适用于诸如输尿管支架取出术等无组织切除的手术。
我们的目的是调查和比较成人及儿科泌尿科医生在输尿管支架取出术抗生素预防方面的实践模式。
向腔内泌尿外科协会（EUS）和儿科泌尿外科学会（SPU）的成员发放了一份在线调查问卷，其中包括有关医疗服务提供者的人口统计学和实践模式的问题。成人泌尿科医生定义为EUS成员受访者，儿科泌尿科医生定义为SPU成员受访者。使用Pearson卡方分析进行比较。
在接受调查的2544名成人泌尿科医生中，258名（10%）完成了调查；在接受调查的714名儿科泌尿科医生中，180名（25%）完成了调查（表1）。儿科泌尿科医生报告在通过导丝或手术室膀胱镜取出支架时，比成人泌尿科医生更常“大多数时候”（即≥75%的时间）使用抗生素预防，但在通过门诊膀胱镜取出支架时则较少。儿科泌尿科医生报告在肾盂成形术、输尿管镜检查和输尿管再植术后比成人泌尿科医生更常“大多数时候”使用抗生素预防。成人和儿科泌尿科医生报告的预防持续时间没有差异，64%给予单次剂量。儿科泌尿科医生报告比成人泌尿科医生更常“大多数时候”进行尿培养（UC）（32%对15%，p<0.001），但根据UC结果报告的抗生素治疗使用情况没有差异。64%的调查受访者报告对UC结果为阴性的患者给予抗生素治疗，93%的调查受访者报告对无症状菌尿（定义为尿培养阳性但无症状的患者）患者使用抗生素治疗。
在接受调查的成人和儿科泌尿科医生中，关于输尿管支架取出术前抗生素预防的报告实践存在差异。总体而言，儿科泌尿科医生报告在输尿管支架取出术前比成人泌尿科医生更常使用抗生素预防。
这种实践差异以及缺乏证据支持在输尿管支架取出术前使用抗生素预防强调了需要进行更多研究，以指导制定针对成人和儿科患者的循证指南。
