Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, China.
Transplantation Center, Xiangya Hospital, Central South University, Changsha, 410008, China.
World J Urol. 2022 Feb;40(2):529-535. doi: 10.1007/s00345-021-03845-9. Epub 2021 Oct 6.
To assess the value of procalcitonin (PCT) as an early biomarker for predicting urosepsis caused by Gram-negative (GN) bacteria, Gram-positive (GP) bacteria and fungi following mini-percutaneous nephrolithotomy (mPCNL) and flexible ureteroscopy (FURS).
A total number of 356 patients with positive preoperative UC (urine cultures) who underwent mPCNL and FURS between June 2017 and January 2021 were retrospectively analyzed. Univariable analysis and multivariable logistic regression analysis were conducted to compare the predictors for urosepsis caused by different organisms. Furthermore, the nomogram was established as a predicted model for urosepsis.
Among 356 positive UC, 265 (74.4%) were positive for GN bacteria, 77 (21.4%) for GP bacteria and 14 (3.9%) for fungal pathogens. Escherichia coli (48.9%) were the predominant pathogens and Enterococcus (54/77) were the most common GP bacteria. Multivariate logistic regression analysis showed that positive nitrite (OR 3.31, 95% CI 1.20-9.14; P = 0.021), operative time > 90 min (OR 3.10, 95% CI 1.10-8.75, P = 0.033) and postoperative PCT > 0.1 ng/mL (OR 56.18, 95% CI 15.20-207.64, P < 0.001) were associated with postoperative urosepsis originated in GN infections, while urosepsis caused by GP bacteria and fungi was not associated with PCT > 0.1 ng/mL (P = 0.198), only stone burden > 800 mm (OR 3.69, 95% CI 1.01-13.53, P = 0.049) was an independent risk factor.
For patients with positive preoperative UC, postoperative PCT > 0.1 ng/mL was an independent risk factor of post-PCNL and post-FURS urosepsis caused by GN bacteria rather than GP bacteria and fungi.
评估降钙素原（PCT）作为一种早期生物标志物，用于预测经皮肾镜碎石术（mPCNL）和输尿管软镜（FURS）术后由革兰氏阴性（GN）细菌、革兰氏阳性（GP）细菌和真菌引起的尿脓毒症。
回顾性分析了 2017 年 6 月至 2021 年 1 月间 356 例经 mPCNL 和 FURS 治疗且术前 UC（尿培养）阳性的患者。采用单变量分析和多变量逻辑回归分析比较不同病原体引起尿脓毒症的预测因素。此外，建立了一个列线图作为预测模型。
在 356 例 UC 阳性的患者中，265 例（74.4%）为 GN 细菌阳性，77 例（21.4%）为 GP 细菌阳性，14 例（3.9%）为真菌病原体阳性。大肠埃希菌（48.9%）是主要病原体，肠球菌（54/77）是最常见的 GP 细菌。多变量逻辑回归分析显示，阳性亚硝酸盐（OR 3.31，95%CI 1.20-9.14；P=0.021）、手术时间>90 分钟（OR 3.10，95%CI 1.10-8.75，P=0.033）和术后 PCT>0.1ng/mL（OR 56.18，95%CI 15.20-207.64，P<0.001）与 GN 感染引起的术后尿脓毒症有关，而 GP 细菌和真菌引起的尿脓毒症与 PCT>0.1ng/mL 无关（P=0.198），仅结石负荷>800mm（OR 3.69，95%CI 1.01-13.53，P=0.049）是独立的危险因素。
对于术前 UC 阳性的患者，术后 PCT>0.1ng/mL 是 GN 细菌引起的 PCNL 和 FURS 术后尿脓毒症的独立危险因素，而不是 GP 细菌和真菌。
