Charton M, Vallancien G, Veillon B, Brisset J M
J Urol. 1986 Jan;135(1):15-7. doi: 10.1016/s0022-5347(17)45500-5.
Percutaneous extraction of renal stones is associated with a risk of infection, which sometimes can be severe as a result of the intraoperative introduction of a ureteral catheter, the nephroscopy itself and the fact that a nephrostomy tube sometimes is left in place. It generally is accepted that patients with a preoperative urinary tract infection should be covered during the operation by an appropriate antibiotic. However, the need for routine prophylactic antibiotic treatment in patients with sterile urine preoperatively still is a subject of debate. We report the bacteriological results of 126 cases of percutaneous extraction of renal stones. Of the patients 107 had sterile urine preoperatively and deliberately did not receive prophylactic antibiotics so that the mechanisms of urinary tract infection after percutaneous nephrolithotomy could be studied. Of these patients 37 (35 per cent) suffered a postoperative urinary tract infection, usually owing to Escherichia coli, streptococcus or staphylococcus. The responsible organism was isolated in the bladder urine only in 22 cases, in the nephrostomy tube in 2 and in both sites in 13. Eleven patients (10 per cent) presented with a fever of 38.5C or more. All of the infected patients received appropriate antibiotic therapy and there were only 2 bacteriological failures on long-term followup (5 per cent). A total of 19 patients had a urinary tract infection preoperatively. All 19 patients received appropriate antibiotic therapy starting at least 24 hours preoperatively and continuing for a minimum of 3 weeks. Five patients (26 per cent) presented with a fewer but there were no serious septic complications. All of the patients were discharged from the hospital with sterile urine and there was only 1 long-term bacteriological failure (5 per cent). Both patients with Pseudomonas infection were cured. The risk of clinical infection following percutaneous nephrolithotomy is low despite the fact that 35 per cent of the patients have bacteriuria postoperatively, provided a careful bacteriological examination is performed preoperatively and the patients with urinary tract infection are treated appropriately. These results are in favor of short-term prophylactic antibiotics adapted to the bacterial ecology.
经皮肾镜取石术存在感染风险，这有时可能很严重，原因在于术中置入输尿管导管、进行肾镜检查本身，以及有时会留置肾造瘘管。一般认为，术前存在尿路感染的患者在手术期间应使用适当的抗生素。然而，术前尿液无菌的患者是否需要常规预防性使用抗生素仍是一个有争议的问题。我们报告了126例经皮肾镜取石术患者的细菌学结果。其中107例患者术前尿液无菌，且故意未接受预防性抗生素治疗，以便研究经皮肾镜取石术后尿路感染的机制。这些患者中有37例（35%）术后发生尿路感染，通常由大肠杆菌、链球菌或葡萄球菌引起。仅在22例患者的膀胱尿液中分离出致病微生物，2例在肾造瘘管中分离出，13例在两个部位均分离出。11例患者（10%）出现体温达38.5℃或更高的发热。所有感染患者均接受了适当的抗生素治疗，长期随访仅有2例细菌学治疗失败（5%）。共有19例患者术前存在尿路感染。所有19例患者至少在术前24小时开始接受适当的抗生素治疗，并持续至少3周。5例患者（26%）出现发热，但无严重的败血症并发症。所有患者出院时尿液无菌，长期细菌学治疗失败仅有1例（5%）。2例铜绿假单胞菌感染患者均治愈。尽管35%的患者术后有菌尿，但经皮肾镜取石术后临床感染风险较低，前提是术前进行仔细的细菌学检查，且对尿路感染患者进行适当治疗。这些结果支持根据细菌生态学使用短期预防性抗生素。
