Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510230, Guangdong, China.
Department of Pharmacy, Guangzhou Institute of Dermatology, Guangzhou, 510095, China.
World J Urol. 2022 Jan;40(1):193-199. doi: 10.1007/s00345-021-03834-y. Epub 2021 Sep 22.
To explore an appropriate duration of antibiotic therapy before percutaneous nephrolithotomy (PCNL) in patients with positive urine culture.
From March 2016 to May 2018, consecutive patients with positive urine culture undergoing PCNL were prospectively registered. Initial preoperative antibiotics were given empirically. If needed, antibiotics were upgraded or adjusted to susceptible antibiotic after obtaining antibiotic-sensitivity test. Postoperative systemic inflammatory response syndrome (SIRS) was the primary outcome.
Among the 220 participants, the incidence of positive stone culture and SIRS were 85.5% and 36.8%. Escherichia coli (53.6%, 44.5%) and Proteus mirabilis (8.2%, 10.0%) were the top two bacteria in urine and stones. In univariable analysis, patients with postoperative SIRS had a higher rate of stone culture positivity (97.5% VS 78.4%, P < 0.001) and a shorter duration of preoperative antibiotics therapy (3.4 ± 2.7 days versus 4.2 ± 2.8 days, P = 0.037). The landscape of SIRS showed a declining trend as the elongation of preoperative antibiotics (P = 0.039). In a day-by-day comparison, SIRS was less prevalent in patients treated by pre-PCNL antibiotics ≥ 7 days than in those with antibiotics ≤ 6 days (21.7% VS 40.8%, P = 0.017). Multivariable logistic regression confirmed positive stone culture (P = 0.001, OR 11.115) as an independent risk factor and pre-PCNL antibiotics ≥ 7 days (P = 0.048, OR 0.449) as an independent protective factor for SIRS. Preoperative antibiotic ≥ 7 days decreased SIRS from 45.4 to 27.8% and from 9.1 to 0% in patients with a positive and negative stone culture, respectively.
Exceeding seven days should be appropriate duration of antibiotic therapy before PCNL in patients with positive urine cultures.
探讨经皮肾镜取石术（PCNL）前阳性尿液培养患者的合适抗生素治疗时间。
2016 年 3 月至 2018 年 5 月，前瞻性登记连续接受 PCNL 治疗的阳性尿液培养患者。术前给予经验性初始抗生素治疗。如果需要，在获得抗生素敏感性试验后，将抗生素升级或调整为敏感抗生素。术后全身炎症反应综合征（SIRS）为主要结局。
220 例患者中，阳性结石培养和 SIRS 的发生率分别为 85.5%和 36.8%。尿液和结石中前两位细菌分别为大肠埃希菌（53.6%，44.5%）和奇异变形杆菌（8.2%，10.0%）。单变量分析显示，术后发生 SIRS 的患者结石培养阳性率更高（97.5%比 78.4%，P<0.001），术前抗生素治疗时间更短（3.4±2.7 天比 4.2±2.8 天，P=0.037）。随着术前抗生素时间的延长，SIRS 的发生情况呈下降趋势（P=0.039）。在逐日比较中，PCNL 前抗生素治疗≥7 天的患者 SIRS 发生率低于抗生素治疗≤6 天的患者（21.7%比 40.8%，P=0.017）。多变量 logistic 回归证实阳性结石培养（P=0.001，OR 11.115）是 SIRS 的独立危险因素，PCNL 前抗生素治疗≥7 天（P=0.048，OR 0.449）是 SIRS 的独立保护因素。术前抗生素治疗≥7 天可将 SIRS 从阳性结石患者的 45.4%降至 27.8%，从阴性结石患者的 9.1%降至 0%。
对阳性尿液培养患者，PCNL 前抗生素治疗时间超过 7 天可能是合适的。
