Lei Min, Jiang Zheng, Xu Peng, Chang Zhenglin, Zhang Yuyan, Zhang Shike, An Lingyue, Li Shujue, Zeng Tao, Tiselius Hans-Göran, Zhou Yuhao, Zeng Guohua, Wu Wenqi
Department of Urology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, 510260, People's Republic of China.
Guangdong Key Laboratory of Urology, Guangzhou Medical University, Guangzhou, Guangdong, 510260, People's Republic of China.
Infect Drug Resist. 2024 Jul 9;17:2873-2882. doi: 10.2147/IDR.S462257. eCollection 2024.
The purpose of this study was to identify bacterial differences between urine cultures (UC) and stone cultures (SC) in patients with complex kidney stones and to determine any correlation with post-percutaneous nephrolithotomy Systemic Inflammatory Response Syndrome (SIRS).
Perioperative data of 1055 patients with complex kidney stones treated with first-stage Percutaneous Nephrolithotomy (PCNL) from September 2016 until September 2021 were included. Preoperative mid-stream urine samples and surgically obtained stone material were subjected to bacterial culture and antibiotic sensitivity tests. Preoperatively, antibiotic usage was determined by the UC or local bacterial resistance patterns. After PCNL treatment, antibiotic selection was guided by stone bacterial culture result and clinical symptoms. The effect of different preoperative antibiotic regimens based on urine cultures and postoperative antibiotic treatment based on stone cultures were assessed.
Positive stone cultures (SC+) were significantly more common than positive urine cultures (UC+) (31.9% vs 20.9%, p < 0.05). () was the most common uropathogen in both urine (54.3%) and stones (43.9%). The difference was statistically significant (p < 0.05). Moreover, UC+SC-, UC-SC+, UC+SC+, and preoperative serum creatinine were independent risk factors of postoperative SIRS. The incidence of SIRS in the UC+SC+ patients with different bacteria in stones and urine (51.6%) was higher than that in other culture groups. The antibiotic resistance of inside the stone was increased when prolonged preoperative antibiotics were administered to UC+ patients.
The bacterial spectrum and positive outcome of culture in urine and stones were significantly different. The incidence of postoperative SIRS was highest in patients with UC+SC+ but with different bacteria strains. Prolonged pre-surgical antibiotic treatment apparently induced higher drug resistance for bacteria inside the stone.
本研究旨在确定复杂性肾结石患者尿液培养（UC）和结石培养（SC）之间的细菌差异，并确定其与经皮肾镜取石术后全身炎症反应综合征（SIRS）的相关性。
纳入2016年9月至2021年9月期间接受一期经皮肾镜取石术（PCNL）治疗的1055例复杂性肾结石患者的围手术期数据。术前中段尿样本和手术获取的结石材料进行细菌培养和药敏试验。术前，根据UC或局部细菌耐药模式确定抗生素使用情况。PCNL治疗后，根据结石细菌培养结果和临床症状指导抗生素选择。评估基于尿液培养的不同术前抗生素方案和基于结石培养的术后抗生素治疗的效果。
阳性结石培养（SC+）比阳性尿液培养（UC+）更常见（31.9%对20.9%，p<0.05）。（）是尿液（54.3%）和结石（43.9%）中最常见的尿路病原体。差异有统计学意义（p<0.05）。此外，UC+SC-、UC-SC+、UC+SC+和术前血清肌酐是术后SIRS的独立危险因素。结石和尿液中细菌不同的UC+SC+患者的SIRS发生率（51.6%）高于其他培养组。对UC+患者延长术前抗生素使用时间时，结石内（）的抗生素耐药性增加。
尿液和结石中的细菌谱及培养阳性结果存在显著差异。UC+SC+但菌株不同的患者术后SIRS发生率最高。术前长时间使用抗生素明显导致结石内细菌的耐药性增加。
