Ahmed Asmaa E, Abol-Enein Hassan, Awadalla Amira, El Degla Heba, El-Shehaby Omar A
Botany Department, Faculty of Science, Mansoura University, Mansoura, Egypt.
Center of Excellence for Genome and Cancer Research, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Infect Drug Resist. 2022 Jul 9;15:3643-3655. doi: 10.2147/IDR.S368852. eCollection 2022.
Nephrolithiasis is a worldwide disease, and 4.7% of the patients may develop postoperative sepsis. Characterization of virulence genes of bacteria associated with renal stones is still lacking in the literature. The study aimed to investigate the virulence genes of the predominant stone bacterial isolate and their association with postoperative septic complications in patients treated with percutaneous nephrolithotomy (PCNL).
Stone and midstream urine samples were collected from 200 nephrolithiasis patients who underwent PCNL. Microbiological examination and virulence profile were studied for the common bacteria isolated from the stones.
Microbiological analysis revealed that was the predominant organism in stone samples (42.8%), while (56.6%) was the dominant pathogen in midstream urine. Eight patients (4%) developed septic complications; stone culture was positive for in seven and in one patient, while all but one had negative midstream urine. The patient with positive midstream urine culture had also infection. Detection of virulence genes in isolated from stones showed a high positivity of the hemolysine gene (93.3%) and adhesion gene (73.3%), whereas enterotoxin genes ( and ) were negative in all stone cultures. Moreover, the adhesion genes ( and ), hemolysine gene (), panton-valentine leukocidin () gene and the enterotoxin gene () were significantly higher in septic patients compared to the non-septic ones (< 0.05). Interestingly, there was a significant relation between the existence of virulence genes and the resistance of antibiotics ( < 0.05).
There has been a notable shift toward gram-positive organisms () in the stone culture. Moreover, virulence genes were significantly attributed to the resistance of some antibiotics and postoperative septic complications, suggesting that the stone culture could be more informative than urine culture, especially in predicting the risk of postoperative sepsis.
肾结石是一种全球性疾病，4.7%的患者术后可能发生脓毒症。文献中仍缺乏对与肾结石相关细菌毒力基因的特征描述。本研究旨在调查经皮肾镜取石术（PCNL）治疗患者中主要结石细菌分离株的毒力基因及其与术后脓毒症并发症的关系。
收集200例行PCNL的肾结石患者的结石和中段尿样本。对从结石中分离出的常见细菌进行微生物学检查和毒力分析。
微生物学分析显示， 是结石样本中的主要微生物（42.8%），而 （56.6%）是中段尿中的主要病原体。8例患者（4%）发生脓毒症并发症；7例患者的结石培养 呈阳性，1例患者 呈阳性，而除1例患者外所有患者的中段尿均为阴性。中段尿培养阳性的患者也有 感染。从结石中分离出的 中检测毒力基因显示，溶血素基因 （93.3%）和黏附基因 （73.3%）的阳性率较高，而所有 结石培养中肠毒素基因（ 和 ）均为阴性。此外，与非脓毒症患者相比，脓毒症患者的黏附基因（ 和 ）、溶血素基因（ ）、杀白细胞素（ ）基因和肠毒素基因（ ）显著更高（ < 0.05）。有趣的是，毒力基因的存在与抗生素耐药性之间存在显著关系（ < 0.05）。
结石培养中革兰氏阳性菌（ ）出现了显著变化。此外， 毒力基因与某些抗生素耐药性和术后脓毒症并发症显著相关，表明结石培养可能比尿培养提供更多信息，特别是在预测术后脓毒症风险方面。
