Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
J Hosp Infect. 2023 Nov;141:99-106. doi: 10.1016/j.jhin.2023.08.021. Epub 2023 Sep 9.
Percutaneous nephrostomy catheters (PCNs) are commonly utilized in patients with gynaecological cancers due to intrinsic or extrinsic urinary obstruction. Unfortunately, these foreign medical devices may be associated with several infectious complications, including: pyelonephritis, renal abscess, and bacteraemia, which may lead to further delay of life-saving cancer therapy.
To evaluate the performance of our multidisciplinary algorithm for diagnosis and treatment of PCN-related infections (PCNIs) and identify risk factors for recurrent urinary device-related infections.
Patients with gynaecological cancers having PCNIs were prospectively evaluated at our institution from July 2019 to September 2021. All patients were managed by our standardized algorithm and followed-up until reinfection or routine PCN exchange.
Of 100 consecutive patients with PCNIs, 74 had adequate follow-up, and were analysed in three groups according to clinical outcome: reinfection with the same organism (26%), reinfection with a different organism (23%), and no reinfection (51%). Their median age was 54 years, and the most common cancers were cervical (65%), and ovarian (19%) with 53% being metastatic. The most frequently recovered micro-organisms were Pseudomonas (32%), Enterococcus (27%), and Escherichia (24%) species. The main risk factors for recurrent PCNI with the same organism were pelvic radiation therapy (P=0.032), pelvic fistulas (P=0.014), and a PCNI with the same pathogen within the previous year (P = 0.012).
Our algorithm has allowed for accurate diagnosis, staging, and treatment of and identification of several key risk factors for recurrent PCNIs. These results may lead to further preventive measures for these infections.
经皮肾造瘘管（PCN）常用于妇科癌症患者，以治疗内在或外在的尿路梗阻。不幸的是，这些外来医疗器械可能与多种感染并发症相关，包括肾盂肾炎、肾脓肿和菌血症，这可能会进一步延误救命的癌症治疗。
评估我们多学科诊断和治疗 PCN 相关感染（PCNI）的算法，并确定复发性尿置管相关感染的危险因素。
2019 年 7 月至 2021 年 9 月，我们机构前瞻性评估了患有 PCNI 的妇科癌症患者。所有患者均按我们的标准算法进行管理，并随访至再次感染或常规更换 PCN。
在 100 例连续的 PCNI 患者中，74 例有足够的随访数据，根据临床结果分为三组：相同病原体的再感染（26%）、不同病原体的再感染（23%）和无再感染（51%）。他们的中位年龄为 54 岁，最常见的癌症是宫颈癌（65%）和卵巢癌（19%），其中 53%为转移性。最常恢复的微生物是假单胞菌（32%）、肠球菌（27%）和大肠埃希菌（24%）。复发性同种病原体 PCNI 的主要危险因素是盆腔放疗（P=0.032）、盆腔瘘（P=0.014）和前一年同种病原体的 PCNI（P=0.012）。
我们的算法能够准确诊断、分期、治疗和确定复发性 PCNI 的几个关键危险因素。这些结果可能会进一步预防这些感染。
