Characteristics of Bacteria in Urine and Stones from Patients Treated with Percutaneous Nephrolithotomy and Association with Postoperative Infection

IF 2.9 3区医学 Q2 INFECTIOUS DISEASES

Infection and Drug Resistance Pub Date : 2024-07-09 DOI:10.2147/idr.s462257

Min Lei, Zheng Jiang, Peng Xu, Zhenglin Chang, Yuyan Zhang, Shike Zhang, Lingyue An, Shujue Li, Tao Zeng, Hans-Göran Tiselius, Yuhao Zhou, Guohua Zeng, Wenqi Wu

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Abstract

Background: 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).
Methods: 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.
Results: Positive stone cultures (SC+) were significantly more common than positive urine cultures (UC+) (31.9% vs 20.9%, p < 0.05). Escherichia coli (E. coli) 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 E. coli inside the stone was increased when prolonged preoperative antibiotics were administered to UC+ patients.
Conclusion: 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.

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经皮肾镜取石术患者尿液和结石中细菌的特征及与术后感染的关系

背景：本研究旨在确定复杂性肾结石患者尿培养（UC）和结石培养（SC）之间的细菌差异，并确定与经皮肾镜取石术后全身炎症反应综合征（SIRS）的相关性：方法：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。对术前中段尿液样本和手术获取的结石材料进行了细菌培养和抗生素敏感性检测。术前，根据 UC 或当地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选择抗生素。根据尿液培养结果评估了不同术前抗生素方案的效果，并根据结石培养结果评估了术后抗生素治疗的效果：结果：结石培养阳性（SC+）明显多于尿液培养阳性（UC+）（31.9% vs 20.9%，p <0.05）。大肠杆菌（E. coli）是尿液（54.3%）和结石（43.9%）中最常见的尿路病原体。两者之间的差异具有统计学意义（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。结石和尿液中含有不同细菌的 UC+SC+ 患者的 SIRS 发生率（51.6%）高于其他培养组。结论：UC+患者术前长期使用抗生素会增加结石内大肠杆菌的抗生素耐药性：结论：尿液和结石中的细菌谱和培养阳性结果存在显著差异。结论：尿液和结石中的细菌谱和培养阳性结果存在明显差异。UC+SC+ 患者术后 SIRS 的发生率最高，但细菌菌株不同。手术前长时间的抗生素治疗显然会诱发结石内细菌产生更强的耐药性。

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来源期刊

Infection and Drug Resistance Medicine-Pharmacology (medical)

CiteScore

5.60

自引率

7.70%

发文量

826

审稿时长

16 weeks

期刊介绍： About Journal Editors Peer Reviewers Articles Article Publishing Charges Aims and Scope Call For Papers ISSN: 1178-6973 Editor-in-Chief: Professor Suresh Antony An international, peer-reviewed, open access journal that focuses on the optimal treatment of infection (bacterial, fungal and viral) and the development and institution of preventative strategies to minimize the development and spread of resistance.