Neheman Amos, Sabler Itay M, Beberashvili Ilia, Goltsman Galina, Verchovsky Guy, Kord Eyal, Yossepowitch Orit, Zisman Amnon, Stav Kobi
Department of Urology, Shamir Medical Center, Zerifin, Israel.
Department of Infectious Diseases, Shamir Medical Center, Zerifin, Israel.
Eur J Pediatr Surg. 2023 Feb;33(1):47-52. doi: 10.1055/a-1905-4460. Epub 2022 Jul 20.
Minimally invasive pyeloplasty (MIP), namely, laparoscopic and robot-assisted interventions, has gained popularity in recent years. Double-J ureteral stents are frequently inserted during surgery. Foreign bodies in the urinary tract are considered as risk factor for developing urinary tract infection (UTI). This study aimed to specify the bacteria cultured from urine and stents responsible for UTI in children with indwelling ureteral stents undergoing MIP.
We retrospectively reviewed medical records of 30 children (22 boys and 8 girls) who had undergone MIP between 2014 and 2017. Median age at surgery was 2.7 years (interquartile range [IQR]: 0.5-7.9). Urine cultures were obtained before surgery, before stent removal, 1 month after stent removal, and if UTI was suspected. Stents were removed 4 to 8 weeks after surgery and cultured. Patients' demographics, types of stents, and surgical details were recorded.
Median stent indwelling time was 5.09 weeks (IQR: 4-6). Postoperative febrile UTI developed in 4/30 (13%) patients. Afebrile UTI occurred in another 4/30 (13%) patients. Stent cultures were positive in 19/30 (63%) patients. Stent and urinary cultures were identical in only one patient. Three of four patients with preoperative asymptomatic bacteriuria developed postoperative UTI. There was no association between UTI, gender, stent diameter, and duration of indwelling catheter.
After MIP, febrile UTI and afebrile UTI occurred in about one quarter of patients. Pathogens isolated postsurgically from urinary cultures were unrelated to those colonizing the stents. Therefore, routine stent culturing is of low clinical significance. Moreover, small-caliber stents and longer indwelling periods were not risk factors for UTI. Optimizing antibiotic treatment for children with preoperative UTI may potentially prevent morbidity after surgery.
近年来，微创肾盂成形术（MIP），即腹腔镜和机器人辅助干预，越来越受欢迎。手术期间常插入双J输尿管支架。尿路中的异物被认为是发生尿路感染（UTI）的危险因素。本研究旨在明确在接受MIP并留置输尿管支架的儿童中，从尿液和支架培养出的导致UTI的细菌。
我们回顾性分析了2014年至2017年间接受MIP的30名儿童（22名男孩和8名女孩）的病历。手术时的中位年龄为2.7岁（四分位间距[IQR]：0.5 - 7.9）。在手术前、支架取出前、支架取出后1个月以及怀疑有UTI时进行尿培养。术后4至8周取出支架并进行培养。记录患者的人口统计学资料、支架类型和手术细节。
支架的中位留置时间为5.09周（IQR：4 - 6）。30例患者中有4例（13%）发生术后发热性UTI。另外4例（13%）患者发生无发热性UTI。30例患者中有19例（63%）支架培养呈阳性。仅1例患者的支架和尿液培养结果相同。4例术前无症状菌尿患者中有3例发生术后UTI。UTI与性别、支架直径和留置导管时间无关。
MIP术后，约四分之一的患者发生发热性UTI和无发热性UTI。术后从尿培养中分离出的病原体与定植在支架上的病原体无关。因此，常规支架培养的临床意义不大。此外，小口径支架和较长的留置时间不是UTI的危险因素。优化术前UTI患儿的抗生素治疗可能有助于预防术后发病。
