Objective To clarify the infection risks and the value of endotoxin determination in urine during extracorporeal shock wave lithotripsy (ESWL).Methods According to the distribution and complications of upper urinary c...Objective To clarify the infection risks and the value of endotoxin determination in urine during extracorporeal shock wave lithotripsy (ESWL).Methods According to the distribution and complications of upper urinary calculi, 164 patients were divided into five groups. Group A consisted of 48 patients with 1 to 4 renal calculi, which were or less than 2 crn in diameter. Group B was composed of 24 patients with renal calculus larger than 2 cm in diameter or one to multiple renal calculi. Group C wes composed of 22 patients with 1 to 3 renal calculi accompanied by 1 to 2 ureteric calculi. Group D consisted of 51 patients with 1 to 3 ureteric calculi that were 0.5 to 1.2 cm in diameter, respectively. Group E included 19 patients with complicated renal calculus, such es casting and staghom renal calculus. Urine and blood samples of these patients were obtained before and after ESWL, respectively. Their urine samples were proven sterile prior to treatment. All samples were cultured for bacteria and investigated for endotoxin concentration by the limulus lysate test.Results No significant difference in serum endotoxin wes noted before and after ESWL. Blood bacterial cultures were all negative in all patients after ESWL, similar to those before ESWL. Significant increases in urine endotoxin after ESWL compared with that before ESWL in patients of Groups B, C and E were observed, respectively (P ＜ 0.05). There was no significant difference in urine endotoxin after ESWL compared with that before ESWL in patients of Groups A and D. The positive incidences of urine bacterial culture were significantly increased (P ＜ 0.05) in Groups B and C and very significantly increased ( P ＜ 0.01 ) in Group E compared with those in Groups A and D.Conclusions Urinary infection risk following ESWL was lower in patients with one to several renal calculi,which were less than 2 cm in diameter and did not interfere obviously with the urine flow or in patients with 1 to 3 ureteric calculi that were 0. 5 to 1.2 cm in diameter. The risk was higher in those with complicated calculi, such as casting, staghom renal calculus, renal calculus larger than 2 cm in diameter or renal calculi accompanied by ureteric calculi. For patients with higher infection risk after ESWL, prophylactic antibiotics are necessary even if bacteriuria is not present before ESWL. Endotoxin determination in urine is a reliable,sensitive and simple method for the diagnosis of bacterial infection in patients undergoing ESWL.展开更多
Background:We have previously demonstrated that blood transfusion(BT)was associated with post-operative complications in patients undergoing surgery for Crohn’s disease(CD),based on our institutional data registry.Th...Background:We have previously demonstrated that blood transfusion(BT)was associated with post-operative complications in patients undergoing surgery for Crohn’s disease(CD),based on our institutional data registry.The aim of this study was to verify the association between perioperative BT and infectious complications in CD patients enrolled in the American College of Surgeons National Surgical Quality Improvement Program(ACS NSQIP)database.Methods:All CD patients undergoing surgery between 2005 and 2013 were identified from NSQIP.Variables were defined according to the ACS NSQIP guidelines.The primary outcome was infectious complications,including superficial,deep and organ/space surgical site infection,wound dehiscence,urinary tract infection,pneumonia,systemic sepsis and septic shock.Multivariate analyses were performed to assess the risk factors for post-operative infections.Results:All 10100 eligible patients were included and 611(6.0%)received perioperative BT.BT patients were older,lighter in weight and more likely to be functionally dependent.BT patients were more likely to have post-operative infectious complications than those without BT,including superficial surgical site infection(SSI)(10.8%vs 7.4%,p¼0.002),deep SSI(3.3%vs 1.6%,p¼0.003),organ/space SSI(14.2%vs 5.4%,p<0.001),pneumonia(3.8%vs 1.3%,p<0.001),urinary tract infection(3.9%vs 2.2%,p¼0.006),sepsis(11.5%vs 4.5%,p<0.001)and sepsis shock(3.1%vs 0.8%,p<0.001).Multivariate analysis showed that intra-and/or post-operative BT was an independent risk factor for post-operative infectious complications(odds ratio[OR]¼2.2;95%confidence interval[CI]:1.8–2.7;p<0.001)and the risk increased with each administered unit of red blood cell(OR¼1.3,95%CI:1.2–1.5).Other independent factors were history of smoking,chronic heart disease,diabetes,hypertension and the use of corticosteroids.Pre-operative BT,however,was not found to be a risk factor to post-operative infections.Conclusions:Intra-and/or post-operative,not pre-operative,BT was found to be associated with an increased risk for postoperative infectious complications in this CD cohort.Therefore,the timing and risks and benefits of BT should be carefully balanced.展开更多
文摘Objective To clarify the infection risks and the value of endotoxin determination in urine during extracorporeal shock wave lithotripsy (ESWL).Methods According to the distribution and complications of upper urinary calculi, 164 patients were divided into five groups. Group A consisted of 48 patients with 1 to 4 renal calculi, which were or less than 2 crn in diameter. Group B was composed of 24 patients with renal calculus larger than 2 cm in diameter or one to multiple renal calculi. Group C wes composed of 22 patients with 1 to 3 renal calculi accompanied by 1 to 2 ureteric calculi. Group D consisted of 51 patients with 1 to 3 ureteric calculi that were 0.5 to 1.2 cm in diameter, respectively. Group E included 19 patients with complicated renal calculus, such es casting and staghom renal calculus. Urine and blood samples of these patients were obtained before and after ESWL, respectively. Their urine samples were proven sterile prior to treatment. All samples were cultured for bacteria and investigated for endotoxin concentration by the limulus lysate test.Results No significant difference in serum endotoxin wes noted before and after ESWL. Blood bacterial cultures were all negative in all patients after ESWL, similar to those before ESWL. Significant increases in urine endotoxin after ESWL compared with that before ESWL in patients of Groups B, C and E were observed, respectively (P ＜ 0.05). There was no significant difference in urine endotoxin after ESWL compared with that before ESWL in patients of Groups A and D. The positive incidences of urine bacterial culture were significantly increased (P ＜ 0.05) in Groups B and C and very significantly increased ( P ＜ 0.01 ) in Group E compared with those in Groups A and D.Conclusions Urinary infection risk following ESWL was lower in patients with one to several renal calculi,which were less than 2 cm in diameter and did not interfere obviously with the urine flow or in patients with 1 to 3 ureteric calculi that were 0. 5 to 1.2 cm in diameter. The risk was higher in those with complicated calculi, such as casting, staghom renal calculus, renal calculus larger than 2 cm in diameter or renal calculi accompanied by ureteric calculi. For patients with higher infection risk after ESWL, prophylactic antibiotics are necessary even if bacteriuria is not present before ESWL. Endotoxin determination in urine is a reliable,sensitive and simple method for the diagnosis of bacterial infection in patients undergoing ESWL.
文摘Background:We have previously demonstrated that blood transfusion(BT)was associated with post-operative complications in patients undergoing surgery for Crohn’s disease(CD),based on our institutional data registry.The aim of this study was to verify the association between perioperative BT and infectious complications in CD patients enrolled in the American College of Surgeons National Surgical Quality Improvement Program(ACS NSQIP)database.Methods:All CD patients undergoing surgery between 2005 and 2013 were identified from NSQIP.Variables were defined according to the ACS NSQIP guidelines.The primary outcome was infectious complications,including superficial,deep and organ/space surgical site infection,wound dehiscence,urinary tract infection,pneumonia,systemic sepsis and septic shock.Multivariate analyses were performed to assess the risk factors for post-operative infections.Results:All 10100 eligible patients were included and 611(6.0%)received perioperative BT.BT patients were older,lighter in weight and more likely to be functionally dependent.BT patients were more likely to have post-operative infectious complications than those without BT,including superficial surgical site infection(SSI)(10.8%vs 7.4%,p¼0.002),deep SSI(3.3%vs 1.6%,p¼0.003),organ/space SSI(14.2%vs 5.4%,p<0.001),pneumonia(3.8%vs 1.3%,p<0.001),urinary tract infection(3.9%vs 2.2%,p¼0.006),sepsis(11.5%vs 4.5%,p<0.001)and sepsis shock(3.1%vs 0.8%,p<0.001).Multivariate analysis showed that intra-and/or post-operative BT was an independent risk factor for post-operative infectious complications(odds ratio[OR]¼2.2;95%confidence interval[CI]:1.8–2.7;p<0.001)and the risk increased with each administered unit of red blood cell(OR¼1.3,95%CI:1.2–1.5).Other independent factors were history of smoking,chronic heart disease,diabetes,hypertension and the use of corticosteroids.Pre-operative BT,however,was not found to be a risk factor to post-operative infections.Conclusions:Intra-and/or post-operative,not pre-operative,BT was found to be associated with an increased risk for postoperative infectious complications in this CD cohort.Therefore,the timing and risks and benefits of BT should be carefully balanced.
