梗阻性输尿管结石和疑似感染：在发生尿脓毒症的情况下，抗菌药物持续时间和从减压到结石治疗的时间对其的影响。

Obstructing Ureteral Calculi and Presumed Infection: Impact of Antimicrobial Duration and Time From Decompression to Stone Treatment in Developing Urosepsis.

机构信息

Department of Surgery, Division of Urology, University of Vermont Medical Center, Burlington, VT.

Department of Surgery, Division of Urology, University of Vermont Medical Center, Burlington, VT; Department of Surgery, King Abdulaziz University, Rabigh, Saudi Arabia.

出版信息

Urology. 2023 Feb;172:55-60. doi: 10.1016/j.urology.2022.10.010. Epub 2022 Nov 2.

DOI:10.1016/j.urology.2022.10.010

PMID:36334770

Abstract

OBJECTIVE

To determine whether the duration of antibiotic treatment and timing between urgent renal decompression and stone intervention impacts the risk of developing urosepsis following definitive stone treatment.

MATERIALS & METHODS: A retrospective review of patients who were diagnosed with obstructive urolithiasis and underwent urgent decompression with a ureteral double J stent or percutaneous nephrostomy at our institution between 2012 and 2018 was performed. We narrowed our analysis to the subset of patients who had suspected infection and received definitive stone treatment at our institution. Demographic, infection and antimicrobial data, and initial admission to stone treatment characteristics were collected. Factors associated with developing urosepsis were analyzed.

RESULTS

We identified 872 patients who were treated with urgent renal decompression, of which 215 were analyzed that had suspected infection and also received definitive stone removal at our institution. Thirty-three had fevers, 64.2% had a positive urine culture, and 45.6% had urosepsis at the initial presentation. The median antibiotics duration post decompression was 13 days (IQR 8-18). The median duration from decompression to stone treatment was 17 days (IQR 12-27). Of all, 4.6% of the patients developed urosepsis post ureteroscopy and 5% post percutaneous nephrolithotomy. No factors were associated with developing urosepsis post stone treatment on logistic regression analyses.

CONCLUSION

In patients requiring urgent decompression for obstructing urolithiasis and suspected infection, the time between decompression and stone treatment and the length of antibiotic exposure did not impact rates of postoperative urosepsis. This highlights the importance of maintaining high clinical suspicion for prolonged use of antibiotics, to prevent overtreatment and possible exacerbation of antibiotic resistance.

摘要

目的

确定抗生素治疗的持续时间以及紧急肾减压与结石干预之间的时间间隔是否会影响明确结石治疗后发生尿脓毒症的风险。

材料与方法

对 2012 年至 2018 年期间在我院接受紧急减压治疗（输尿管双 J 支架或经皮肾造口术）并确诊为梗阻性尿石症的患者进行回顾性分析。我们将分析范围缩小至在我院接受疑似感染且接受明确结石治疗的患者子集。收集人口统计学、感染和抗菌药物数据以及初始入院结石治疗特征。分析与发生尿脓毒症相关的因素。

结果

我们确定了 872 例接受紧急肾减压治疗的患者，其中 215 例分析认为存在疑似感染且在我院接受明确结石清除治疗。33 例发热，64.2%的患者尿液培养阳性，45.6%的患者初始表现为尿脓毒症。减压后抗生素治疗的中位数持续时间为 13 天（IQR 8-18）。从减压到结石治疗的中位数时间为 17 天（IQR 12-27）。所有患者中，输尿管镜术后 4.6%和经皮肾镜取石术后 5%发生尿脓毒症。 logistic 回归分析未发现与结石治疗后发生尿脓毒症相关的因素。