标准抗生素预防措施与强化预防措施对输尿管软镜检查术后尿路感染发生率影响的随机对照比较

Randomized comparison of effect of standard antibiotic prophylaxis versus enhanced prophylactic measures on rate of urinary tract infection after flexible ureteroscopy.

作者信息

El-Agamy El-Sayed I, Elhelaly Mohamed A, Abouelgreed Tamer A, Abdrabuh Abdrabuh M, Elebiary Mohamed F, Elatreisy Adel, Ghoneimy Osama M, Fathi Basem A, Zamra Mohamed, Kutub Khalid

机构信息

Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo; Department of Urology, Armed Forced Hospital, Alhada, KSA.

Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo; Gulf Medical University, UAE.

出版信息

Arch Ital Urol Androl. 2023 Mar 15;95(1):11084. doi: 10.4081/aiua.2023.11084.

DOI:10.4081/aiua.2023.11084

PMID:36924374

Abstract

PURPOSE

To compare the rate of post-flexible ureteroscopy urinary tract infection (UTI) in patients subjected to the standard antibiotic prophylaxis alone versus enhanced prophylactic measures.

METHODS

A prospective randomized controlled study included 256 patients subjected to flexible ureteroscopy (FURS) for ureteral or renal stones from March 2018 to July 2022. Treatment groups included the standard antibiotic prophylaxis group (group 1, n=128) and the enhanced prophylaxis group (group 2, n=128). Patients in group 1 were injected with intravenous fluoroquinolone one hour preoperatively, and oral antibiotics were used for 24 h postoperatively. Patients in group 2 had urine culture ten days before the procedure; antibiotic-culture based was given for positive asymptomatic cases, while the procedure was deferred for active UTI.

RESULTS

The study groups were comparable regarding patient demographics, stone characteristics, operative time, and intraoperative complications. The overall hospitalization time was 1.68 ± 0.81 days. Postoperative, and overall complications were significantly higher in group 1 (15.6% vs. 6.3%, p = 0.04 and 26.6% vs. 17.2%, p = 0.047), respectively. Twenty patients (15.6 %) in the standard prophylaxis group were diagnosed with UTI in comparison to 8 patients (6.3 %) in the enhanced prophylaxis group (p = 0.047).

CONCLUSIONS

Urinary tract infection after FURS could be reduced significantly by utilizing the suggested enhanced prophylactic approach.

摘要

目的

比较单纯采用标准抗生素预防措施与强化预防措施的患者在软性输尿管镜检查术后尿路感染（UTI）的发生率。

方法

一项前瞻性随机对照研究纳入了2018年3月至2022年7月间因输尿管或肾结石接受软性输尿管镜检查（FURS）的256例患者。治疗组包括标准抗生素预防组（第1组，n = 128）和强化预防组（第2组，n = 128）。第1组患者在术前1小时静脉注射氟喹诺酮，并在术后使用口服抗生素24小时。第2组患者在手术前10天进行尿培养；无症状阳性病例给予基于抗生素培养结果的治疗，而活动性UTI患者则推迟手术。

结果

研究组在患者人口统计学、结石特征、手术时间和术中并发症方面具有可比性。总体住院时间为1.68±0.81天。术后及总体并发症在第1组显著更高（分别为15.6%对6.3%，p = 0.04；26.6%对17.2%，p = 0.047）。标准预防组有20例患者（15.6%）被诊断为UTI，而强化预防组为8例患者（6.3%）（p = 0.047）。