Son Young, Dalton Raeann, Daidone Camryn, Lince Kimberly, Flemming Joseph, Wu Edward, Serpico Scott, Thomas Brian, Scali Julia, Earnshaw Lance, Patel Bhavik, Akanda Shawon, Weldekidan Blen, Alzubaidi Maha, Dean Gregory
Jefferson New Jersey Urology, Stratford, NJ; Philadelphia College of Osteopathic Medicine, Philadelphia, PA.
Rowan University School of Osteopathic Medicine, Stratford, NJ.
Urology. 2024 Jan;183:176-184. doi: 10.1016/j.urology.2023.09.003. Epub 2023 Sep 28.
To unveil this association, we hypothesize that preoperative and intraoperative urinary tract infection (UTI) will be correlated with postoperative UTI and sepsis occurrence.
The 2020 National Surgical Quality Improvement Program Pediatric (NSQIP-P) data was analyzed for patients undergoing ureteroneocystostomy (UNC) for vesicoureteral reflux (VUR). Patients that underwent UNC for treatment of VUR with urine culture obtained within 2weeks preoperatively or on the day of surgery were identified. The patients were divided into 3 groups: no bacterial growth, bacterial growth with UTI, and bacterial growth polymicrobial growth. Patient demographics and preoperative variables were evaluated.
The postoperative urinary tract infection rate of the three groups were 2.0%, 9.2%, and 9.9% for group A, B, C, respectively (P < .001). Postoperative sepsis was noted to be 0.5%, 1.3%, and 3.6% for group A, B, C (P < .01). Additionally, there was a difference between mean operative time (P < .001), mean length of stay (P = .03), and mean days from operation to discharge (P < .01). On adjusted analysis, both groups B and C had higher rates of UTI compared to group A. Group C was also seen to have greater rates of sepsis on adjusted analysis.
The association found between preoperative UTI with less than 2 species of microorganisms (group B) and postoperative UTI indicates that UTI treatment and antibiotic prophylaxis should be considered when undergoing UNC for VUR. The results of this study may lead to more careful consideration of the use of preoperative and intraoperative urine culture as well as treatment of UTI in pediatric patients with VUR undergoing UNC.
为揭示这种关联，我们假设术前和术中尿路感染（UTI）将与术后UTI及脓毒症的发生相关。
分析2020年国家外科质量改进计划儿科（NSQIP - P）中因膀胱输尿管反流（VUR）接受输尿管膀胱吻合术（UNC）患者的数据。确定术前2周内或手术当天进行尿培养且因VUR接受UNC治疗的患者。患者分为3组：无细菌生长、有UTI的细菌生长、多微生物生长的细菌生长。评估患者人口统计学和术前变量。
A、B、C组术后尿路感染率分别为2.0%、9.2%和9.9%（P <.001）。A、B、C组术后脓毒症发生率分别为0.5%、1.3%和3.6%（P <.01）。此外，平均手术时间（P <.001）、平均住院时间（P =.03）以及从手术到出院的平均天数（P <.01）存在差异。经调整分析，B组和C组的UTI发生率均高于A组。经调整分析还发现C组脓毒症发生率更高。
术前UTI（微生物种类少于2种，即B组）与术后UTI之间的关联表明，因VUR接受UNC手术时应考虑UTI治疗和抗生素预防。本研究结果可能会促使人们更谨慎地考虑对接受UNC手术的VUR儿科患者进行术前和术中尿培养以及UTI治疗。
