Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 25000, Besançon, France.
University of Franche-Comté, 25000, Besançon, France.
Urolithiasis. 2024 Mar 11;52(1):45. doi: 10.1007/s00240-024-01546-7.
Prevalence of kidney stones is increasing worldwide, flexible ureterorenoscopy (f-URS) is the most common surgical treatment. Postoperative urinary tract infection (PUTI) is the primary complication. Some risk factors are classically associated with PUTI, especially preoperative positive urinalysis (POPU). We aimed to identify risk factors for PUTI after f-URS for urolithiasis in patients with treated POPU, and to identify the different pre and postoperative pathogens. Retrospective, single-center study of all f-URS for urolithiasis between January 2004 and December 2020. Procedures with treated POPU were categorized as PUTI or no PUTI (NPUTI). We examined demographics, preoperative, perioperative and postoperative characteristics in each group. Among 1934 procedures analyzed, 401 (20.7%) had POPU; these were categorized into NPUTI (n = 352, 87.8%) and PUTI (n = 49, 12.2%). By univariate analysis, only preoperative stenting duration (76.3 in NPUTI group vs 107.7 days in PUTI group, p = 0.001) was significantly associated with a higher risk of PUTI in univariate analysis. Germ distribution was similar in both groups. We compared pre- and postoperative microbiological data for interventions with PUTI, and found that only 8.7% of pathogens were identical between pre and postoperative urinalysis. Our study shows that the rate of PUTI is higher for patients with a POPU and that preoperative stent duration is the sole risk factor in patients with POPU. The low concordance rate (8.7%) between POPU and post-operative pathogens highlights the need for further research on obtaining sterile preoperative urinalysis, or performing intraoperative culture (urines, stent or stone), to treat PUTI early with an adapted antibiotic therapy.
肾结石的发病率在全球范围内呈上升趋势，软性输尿管镜检查（f-URS）是最常见的手术治疗方法。术后尿路感染（PUTI）是最常见的并发症。一些危险因素与 PUTI 密切相关，尤其是术前尿分析阳性（POPU）。我们旨在确定接受 POPU 治疗的肾结石患者 f-URS 术后发生 PUTI 的危险因素，并确定术前和术后不同的病原体。这是一项回顾性、单中心研究，纳入了 2004 年 1 月至 2020 年 12 月期间所有接受 f-URS 治疗的肾结石患者。将有 POPU 的手术分为 PUTI 或无 PUTI（NPUTI）。我们检查了每组患者的人口统计学、术前、围手术期和术后特征。在分析的 1934 例手术中，401 例（20.7%）有 POPU；将其分为 NPUTI（n=352，87.8%）和 PUTI（n=49，12.2%）。单因素分析显示，只有术前支架放置时间（NPUTI 组 76.3 天 vs PUTI 组 107.7 天，p=0.001）与 PUTI 风险显著相关。两组的菌群分布相似。我们比较了有 PUTI 的干预措施的术前和术后微生物学数据，发现只有 8.7%的病原体在术前和术后尿分析中是相同的。我们的研究表明，POPU 患者的 PUTI 发生率更高，且 POPU 患者的唯一危险因素是术前支架放置时间。POPU 和术后病原体之间的低一致性率（8.7%）强调了需要进一步研究如何获得无菌性术前尿分析，或进行术中培养（尿液、支架或结石），以便尽早使用适应性抗生素治疗来治疗 PUTI。
