术前复查尿培养在预测微通道经皮肾镜取石术相关感染并发症中的作用

Role of preoperative urine culture re-examination in the prediction of infectious complications related to mini-percutaneous nephrolithotomy

目的探讨术前尿培养阳性肾结石患者经过敏感抗生素治疗后,复查尿培养对于预测微通道经皮肾镜碎石取石术(PCNL)相关感染并发症的作用。方法前瞻性、连续性收集在广州医科大学附属第一医院泌尿外科三区术前尿培养阳性并接受微通道PCNL治疗患者的临床资料,根据术前尿培养的药物敏感试验结果,对患者行敏感抗生素治疗,分别在第3、7天复查尿培养。患者经过敏感抗生素治疗7 d后接受微通道PCNL治疗,分析第3、7 d的尿培养结果与微通道PCNL术后相关感染并发症的相关性。结果2021年3月至2023年4月共收集100例患者临床资料,单因素分析的结果显示年龄、性别、糖尿病史、术前静脉血白细胞、手术时间≥90 min等与微通道PCNL术后相关感染并发症无明显相关性(P>0.05)。第3天复查尿培养,阴性95例,术后出现发热20例,其中脓毒症3例;尿培养阳性5例,术后发热1例,其中脓毒症1例。第7天复查尿培养,阴性95例,术后出现发热19例,其中脓毒血症4例;尿培养阳性5例,术后出现发热2例,无脓毒血症。单因素分析结果显示第3、7天尿培养结果与微通道PCNL相关感染并发症无明显相关性(P>0.05)。结论术前尿培养阳性肾结石患者经过敏感抗生素治疗,复查尿培养对微通道PCNL术后相关感染性并发症的预测价值有限。对于术前尿培养阳性患者,建议使用敏感抗生素治疗7 d后再行微通道PCNL。

Objective To explore the predictive value of urine culture re-examination in identifying infectious complications associated with mini-PCNL in patients with preoperative positive urine culture who were treated with sensitive antibiotics.Methods Prospective and consecutive clinical data were collected from patients whose preoperative urine culture was positive and who underwent PCNL at the Department of Urology,the First Affiliated Hospital of Guangzhou Medical University.If patients’preoperative urine cultures were positive,they would be treated with appropriate antibiotics in accordance with the culture-antibiogram test results,and urine cultures were repeated on day 3 and day 7.Patients would undergo mini-PCNL after the treatment of sensitive antibiotics for 7 days,and the correlation between the results of urine culture on day 3 and day 7 and infectious complications related to mini-PCNL after surgery was analyzed.Results From March 2021 to April 2023,a total of 100 patients'clinical data were collected.Univariate analysis showed that the factors including age,gender,diabetes history,preoperative venous leukocyte,and operation time were not significantly correlated with infection complications after mini-PCNL surgery(P>0.05).Reexamination of urine culture on the third day showed negative results in 95 cases,postoperative fever in 20 cases,including 3 cases of sepsis,positive urine culture in 5 cases,postoperative fever in 1 case,including sepsis in 1 case.Reexamination of urine culture on the 7th day showed negative results in 95 cases,19 cases developed fever after operation,including 4 cases of sepsis.Urine culture was positive in 5 cases,and postoperative fever occurred in 2 cases without sepsis.Univariate analysis showed the results of urine culture on day 3 and 7 were not significantly correlated with infectious complications after mini-PCNL surgery(P>0.05).Conclusions The value of re-examination of urine culture in predicting postoperative infectious complications related to mini-PCNL is limited in patients with positive urine culture treated with sensitive antibiotics before surgery.For patients with positive urine culture before surgery,it is recommended to perform mini-PCNL after 7 days of treatment with sensitive antibiotics.