Department of Urology, The Second Affiliated Hospital of Guangzhou Medical University, 250 Changgang Road, Haizhu District, Guangzhou, 510260, Guangdong, China.
Guangdong Key Laboratory of Urology, Guangzhou Medical University, Guangzhou, China.
BMC Urol. 2022 Aug 30;22(1):136. doi: 10.1186/s12894-022-01092-7.
Correct perioperative antibiotic strategies are crucial to prevent postoperative infections during percutaneous nephrolithotomy (PCNL). We aimed to compare the realistic antibiotic strategies applied in China with current urological guidelines.
Between April and May 2020, urologists from China were invited to finish an online cross-sectional survey. The questionnaire was designed according to the current urological guidelines and literatures.
3393 completed responses were received. 61.1% (2073/3393) respondents had urological experience of more than 10 years. 72.4% urologists chose multiple-dose antibiotics for patients with both negative urine culture (UC-) and negative urine microscopy (UM-) preoperatively. Respondents in central China (OR = 1.518; 95% CI 1.102-2.092; P = 0.011), east China (OR = 1.528; 95% CI 1.179-1.979; P = 0.001) and northeast China (OR = 1.904; 95% CI 1.298-2.792; P = 0.001) were more likely to prescribe multiple-dose antibiotic for UC-UM- patients. Notably, the respondents who finished PCNL exceeded 100 cases per year were in favor of single-dose administration (OR = 0.674; 95% CI 0.519-0.875; P = 0.003). There are only 8.3% urologists chose single-dose antibiotic for UC-UM+ patients, whereas 65.5% administered antibiotics for 1-3 days. Meanwhile, for UC+ patients, 59.0% of the urologists applied antibiotics shorter than 1 week, and only 26.3% of the urologists carried out routine re-examination of UC. Moreover, postoperative antibiotics were frequently prescribed for 3-6 days (1815; 53.5%). Finally, although 88.2% urologists considered stone culture important for management of postoperative antibiotics as the guideline recommended, only 18.5% performed it routinely.
The antibiotic strategies are different between current practice in China and the urological guidelines. The dissimilarities suggested that further studies should be conducted to investigate the reasons of the differences and standardize the application of antibiotics.
正确的围手术期抗生素策略对于预防经皮肾镜取石术（PCNL）后的术后感染至关重要。我们旨在比较中国目前实际应用的抗生素策略与当前的泌尿科指南。
2020 年 4 月至 5 月期间，邀请中国的泌尿科医生完成了一项在线横断面调查。该问卷是根据当前的泌尿科指南和文献设计的。
共收到 3393 份完整回复。61.1%（2073/3393）的受访者具有 10 年以上的泌尿科经验。72.4%的泌尿科医生选择对术前尿液培养（UC-）和尿液显微镜检查（UM-）均为阴性的患者使用多剂量抗生素。来自中国中部（OR=1.518；95%CI 1.102-2.092；P=0.011）、东部（OR=1.528；95%CI 1.179-1.979；P=0.001）和东北部（OR=1.904；95%CI 1.298-2.792；P=0.001）的受访者更有可能为 UC-UM-患者开具多剂量抗生素。值得注意的是，每年完成 PCNL 手术超过 100 例的受访者更倾向于单次给药（OR=0.674；95%CI 0.519-0.875；P=0.003）。仅有 8.3%的泌尿科医生选择对 UC-UM+患者使用单剂量抗生素，而 65.5%的医生使用抗生素 1-3 天。同时，对于 UC+患者，59.0%的泌尿科医生使用的抗生素疗程短于 1 周，只有 26.3%的泌尿科医生常规复查 UC。此外，术后抗生素经常开具 3-6 天（1815；53.5%）。最后，尽管 88.2%的泌尿科医生认为结石培养对于管理术后抗生素如指南所建议的那样很重要，但只有 18.5%的医生常规进行该操作。
中国目前的实践与泌尿科指南之间的抗生素策略存在差异。这些差异表明，应进一步进行研究以调查差异的原因，并规范抗生素的应用。
