T Imzharov, B Zhakiev, M Sarkulov, V Pavlov, O Kurmangaliev
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The search strategy was built around key phrases such as 'infected kidney stones,' 'metaphylaxis,' 'antibiotic resistance,' 'percutaneous nephrolithotripsy,' and 'struvite stones.' Clinical trials, cohort and case-control studies with at least 20 participants were included; animal studies and case reports were excluded. Study selection was conducted by two independent reviewers. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale.</p><p><strong>Results: </strong>Forty-seven studies from 23 countries (n=8342) were analysed. Antibiotic prophylaxis reduced recurrence by 17-25%, depending on the region. Struvite stones accounted for 67.3%, with associations to Proteus mirabilis (38.4%) and Escherichia coli (29.6%). Antibiotic resistance reached 43.2%, with peaks for ampicillin (71%) and ciprofloxacin (48%). Complications after PCNL occurred in 12-28% of cases, including sepsis (3.4%) and pyonephrosis (7.8%). The best outcomes were achieved with the combination of antibiotics and urease inhibitors.</p><p><strong>Conclusions: </strong>Comprehensive metaphylaxis adapted to local sensitivity profiles significantly reduces the risk of recurrence. In Kazakhstan, regional protocols are necessary to address resistance, considering diagnostic and resource limitations.</p>","PeriodicalId":12610,"journal":{"name":"Georgian medical news","volume":" 364-365","pages":"314-322"},"PeriodicalIF":0.0000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"THE EFFECTIVENESS OF METAPHYLAXIS OF NEPHROLITHIASIS DURING PERCUTANEOUS NEPHROLITHOTRIPSY: A SYSTEMATIC REVIEW AND METAANALYSIS.\",\"authors\":\"T Imzharov, B Zhakiev, M Sarkulov, V Pavlov, O Kurmangaliev\",\"doi\":\"\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Relevance: </strong>Infected kidney stones, particularly struvite and carbonate-apatite calculi, pose a serious medical challenge due to recurrent urinary tract infections, rising antibiotic resistance, and complications following percutaneous nephrolithotripsy (PCNL).</p><p><strong>Aim: </strong>To assess the effectiveness of metaphylaxis of infected kidney stones, investigate their composition, analyse antibiotic resistance, and determine the incidence of infectious complications after percutaneous nephrolithotripsy.</p><p><strong>Methods: </strong>A comprehensive literature review was performed by searching PubMed, Scopus, and the Cochrane Central Register of Controlled Trials for publications between 2014 and 2024. 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引用次数: 0
摘要
相关性：感染的肾结石，特别是鸟粪石结石和碳酸盐-磷灰石结石，由于尿路感染复发、抗生素耐药性上升和经皮肾镜碎石（PCNL）后的并发症，构成了严重的医学挑战。目的：评价感染肾结石过敏反应的疗效，调查其组成，分析抗生素耐药性，确定经皮肾镜碎石术后感染并发症的发生率。方法：通过检索PubMed、Scopus和Cochrane Central Register of Controlled Trials，对2014年至2024年的出版物进行全面的文献综述。搜索策略是围绕“感染肾结石”、“过敏反应”、“抗生素耐药性”、“经皮肾镜碎石术”和“鸟粪石结石”等关键词建立的。纳入至少20名受试者的临床试验、队列研究和病例对照研究；排除了动物研究和病例报告。研究选择由两名独立审稿人进行。纳入研究的方法学质量采用纽卡斯尔-渥太华量表进行评估。结果：分析了来自23个国家的47项研究（n=8342）。抗生素预防可减少17-25%的复发率，视地区而定。鸟粪石结石占67.3%，与变形杆菌（38.4%）和大肠杆菌（29.6%）相关。抗生素耐药率为43.2%，以氨苄西林（71%）和环丙沙星（48%）最高。PCNL术后并发症发生率为12-28%，包括脓毒症（3.4%）和肾盂积水（7.8%）。抗生素联合脲酶抑制剂治疗效果最好。结论：适应局部敏感性的综合过敏反应可显著降低复发风险。在哈萨克斯坦，考虑到诊断和资源限制，有必要制定区域方案来解决耐药性问题。
THE EFFECTIVENESS OF METAPHYLAXIS OF NEPHROLITHIASIS DURING PERCUTANEOUS NEPHROLITHOTRIPSY: A SYSTEMATIC REVIEW AND METAANALYSIS.
Relevance: Infected kidney stones, particularly struvite and carbonate-apatite calculi, pose a serious medical challenge due to recurrent urinary tract infections, rising antibiotic resistance, and complications following percutaneous nephrolithotripsy (PCNL).
Aim: To assess the effectiveness of metaphylaxis of infected kidney stones, investigate their composition, analyse antibiotic resistance, and determine the incidence of infectious complications after percutaneous nephrolithotripsy.
Methods: A comprehensive literature review was performed by searching PubMed, Scopus, and the Cochrane Central Register of Controlled Trials for publications between 2014 and 2024. The search strategy was built around key phrases such as 'infected kidney stones,' 'metaphylaxis,' 'antibiotic resistance,' 'percutaneous nephrolithotripsy,' and 'struvite stones.' Clinical trials, cohort and case-control studies with at least 20 participants were included; animal studies and case reports were excluded. Study selection was conducted by two independent reviewers. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale.
Results: Forty-seven studies from 23 countries (n=8342) were analysed. Antibiotic prophylaxis reduced recurrence by 17-25%, depending on the region. Struvite stones accounted for 67.3%, with associations to Proteus mirabilis (38.4%) and Escherichia coli (29.6%). Antibiotic resistance reached 43.2%, with peaks for ampicillin (71%) and ciprofloxacin (48%). Complications after PCNL occurred in 12-28% of cases, including sepsis (3.4%) and pyonephrosis (7.8%). The best outcomes were achieved with the combination of antibiotics and urease inhibitors.
Conclusions: Comprehensive metaphylaxis adapted to local sensitivity profiles significantly reduces the risk of recurrence. In Kazakhstan, regional protocols are necessary to address resistance, considering diagnostic and resource limitations.
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