Krzos Paula M, Nguyen Cynthia T, Kane Brenna, Krishnamoorthy Sambhavi, Kristof Tanya W, Reynolds Luke F, Pisano Jennifer, Josephson Michelle A, Barth Rolf, Owen Derek
Department of Pharmacy, University of Chicago Medicine, Chicago, Illinois, USA.
Section of Nephrology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA.
Open Forum Infect Dis. 2024 Sep 5;11(9):ofae510. doi: 10.1093/ofid/ofae510. eCollection 2024 Sep.
Existing literature on best practices to reduce the risk of infectious complications associated with ureteral stent removal in kidney transplant recipients is limited. Prior to 2021, a formal process surrounding stent removal was not in place at our institution. In June 2021, a stent removal protocol was established. This protocol included the following: obtaining a preprocedure urine culture, prescribing universal culture-directed antimicrobial prophylaxis, earlier stent removal posttransplant, and patient education. We performed a retrospective quasi-experimental study of kidney transplant recipients who had their stents removed between July 2020 and June 2022. The primary outcome was the incidence of infectious complications within 30 days. Infectious complications were defined as urinary tract infection and bacteremia due to urinary source, as well as hospitalization, emergency department visit, or outpatient encounter for possible urinary tract infection. Secondary objectives included infectious and immunologic complications within 30 days to 1 year from transplant. During this study period, 239 adult kidney transplant recipients were included: 88 in the preprotocol group and 151 in the protocol group. The median time to stent removal was shorter in the protocol group (25 vs 36 days, < .001). More patients in the protocol group received preprocedure antibiotics (99% vs 36%, < .001). Infectious complications were higher in the preprotocol group (9% vs 3%, = .035). Overall, the stent removal protocol was associated with fewer infectious complications (odds ratio, 0.18; 95% CI, 0.05-0.73). Further investigation is necessary to determine which individual interventions, if any, drive this benefit.
关于降低肾移植受者输尿管支架取出相关感染并发症风险的最佳实践的现有文献有限。在2021年之前，我们机构没有围绕支架取出的正式流程。2021年6月，制定了一项支架取出方案。该方案包括以下内容：术前进行尿培养、开具通用的针对培养结果的抗菌预防用药、移植后更早取出支架以及对患者进行教育。我们对2020年7月至2022年6月期间取出支架的肾移植受者进行了一项回顾性准实验研究。主要结局是30天内感染并发症的发生率。感染并发症定义为因泌尿系统来源导致的尿路感染和菌血症，以及因可能的尿路感染而住院、急诊就诊或门诊就诊。次要目标包括移植后30天至1年内的感染和免疫并发症。在本研究期间，纳入了239名成年肾移植受者：方案前组88例，方案组151例。方案组的支架取出中位时间较短（25天对36天，P<0.001）。方案组中更多患者接受了术前抗生素治疗（99%对36%，P<0.001）。方案前组的感染并发症发生率更高（9%对3%，P=0.035）。总体而言，支架取出方案与较少的感染并发症相关（优势比，0.18；95%置信区间，0.05 - 0.73）。有必要进一步研究以确定是哪些个体干预措施（如果有的话）带来了这一益处。
