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

doi:10.3877/cma.j.issn.1674-3253.2023.04.010

Abstract

Abstract:

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.

Key words: Percutaneous nephrolithotomy, Urine culture, Antibiotics, Sepsis, Infectious complication

Shangwen Dou, Huan Deng, Bangfeng Liu, Gaoyuanzhi Yue, Huacai Zhu, Yongda Liu. Role of preoperative urine culture re-examination in the prediction of infectious complications related to mini-percutaneous nephrolithotomy[J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(04): 361-366.

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References 19

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组别	例数	年龄(岁)	BMI(kg/m²)	术前静脉血白细胞计数(×10⁹/L)	术前血红蛋白(g/L)	术前中性粒细胞数(×10⁹/L)	术前白蛋白(g/L)	术前血清肌酐(μmol/L)
发热组	21	45(35，57)	26.2(21.4，28.1)	6.9(6.0，7.6)	128(118，141)	4.1(3.4，5.2)	40(38，44)	85(82，129)
无发热组	79	54(48，62)	23.0(21.0，26.4)	7.2(6.4，8.6)	131(119，143)	4.5(3.7，6.0)	41(38，43)	92(69，121)
Z值		1.816	1.333	1.143	0.017	0.957	0.114	0.330
P值		0.069	0.183	0.253	0.986	0.339	0.909	0.741
组别	性别		高血压	糖尿病	ESBL阳性	亚硝酸盐试验阳性	鹿角型结石	多通道	手术≥90 min
组别	男	女	高血压	糖尿病	ESBL阳性	亚硝酸盐试验阳性	鹿角型结石	多通道	手术≥90 min
发热组	5	16	08	04	03	13	11	13	10
无发热组	27	52	21	13	22	45	25	31	43
χ²值	0.820		1.068	0.000	1.627	0.166	3.096	3.459	0.309
P值	0.365		0.301	>0.999	0.202	0.683	0.078	0.063	0.578

组别	例数	年龄(岁)	BMI(kg/m²)	术前静脉血白细胞计数(×10⁹/L)	术前血红蛋白(g/L)	术前中性粒细胞数(×10⁹/L)	术前白蛋白(g/L)	术前血清肌酐(μmol/L)
发热组	21	45(35，57)	26.2(21.4，28.1)	6.9(6.0，7.6)	128(118，141)	4.1(3.4，5.2)	40(38，44)	85(82，129)
无发热组	79	54(48，62)	23.0(21.0，26.4)	7.2(6.4，8.6)	131(119，143)	4.5(3.7，6.0)	41(38，43)	92(69，121)
Z值		1.816	1.333	1.143	0.017	0.957	0.114	0.330
P值		0.069	0.183	0.253	0.986	0.339	0.909	0.741
组别	性别		高血压	糖尿病	ESBL阳性	亚硝酸盐试验阳性	鹿角型结石	多通道	手术≥90 min
组别	男	女	高血压	糖尿病	ESBL阳性	亚硝酸盐试验阳性	鹿角型结石	多通道	手术≥90 min
发热组	5	16	08	04	03	13	11	13	10
无发热组	27	52	21	13	22	45	25	31	43
χ²值	0.820		1.068	0.000	1.627	0.166	3.096	3.459	0.309
P值	0.365		0.301	>0.999	0.202	0.683	0.078	0.063	0.578

组别	例数	年龄(岁)	BMI(kg/m²)	术前静脉血白细胞计数(×10⁹/L)	术前血红蛋白(g/L)	术前中性粒细胞数(×10⁹/L)	术前白蛋白(g/L)
脓毒血症组	4	36(27，64)	21.0(16.5，23.2)	7.0(6.7，9.4)	119(109，144)	4.6(4.2，6.0)	40(37，43)
非脓毒血症组	96	53(44，62)	23.4(21.0，26.9)	7.1(6.2，8.5)	131(119，143)	4.4(3.5，5.9)	41(38，43)
Z值		1.294	1.654	0.264	0.713	0.669	0.325
P值		0.196	0.098	0.792	0.476	0.504	0.745
组别	术前血清肌酐(μmol/L)	性别		高血压	糖尿病	ESBL阳性	亚硝酸盐试验阳性	鹿角型结石	多通道	手术≥90 min
组别	术前血清肌酐(μmol/L)	男	女	高血压	糖尿病	ESBL阳性	亚硝酸盐试验阳性	鹿角型结石	多通道	手术≥90 min
脓毒血症组	117(62，196)	01	03	01	01	01	04	02	03.	02
非脓毒血症组	089(70，122)	31	65	28	16	24	54	34	41	51
统计值	Z=-0.431	χ²<0.001		χ²<0.001	-	χ²<0.001	χ²=1.489	χ²=0.004	χ²=0.579	χ²<0.001
P值	0.666	>0.999		>0.999	0.531	>0.999	0.222	0.949	0.447	>0.999

组别	例数	年龄(岁)	BMI(kg/m²)	术前静脉血白细胞计数(×10⁹/L)	术前血红蛋白(g/L)	术前中性粒细胞数(×10⁹/L)	术前白蛋白(g/L)
脓毒血症组	4	36(27，64)	21.0(16.5，23.2)	7.0(6.7，9.4)	119(109，144)	4.6(4.2，6.0)	40(37，43)
非脓毒血症组	96	53(44，62)	23.4(21.0，26.9)	7.1(6.2，8.5)	131(119，143)	4.4(3.5，5.9)	41(38，43)
Z值		1.294	1.654	0.264	0.713	0.669	0.325
P值		0.196	0.098	0.792	0.476	0.504	0.745
组别	术前血清肌酐(μmol/L)	性别		高血压	糖尿病	ESBL阳性	亚硝酸盐试验阳性	鹿角型结石	多通道	手术≥90 min
组别	术前血清肌酐(μmol/L)	男	女	高血压	糖尿病	ESBL阳性	亚硝酸盐试验阳性	鹿角型结石	多通道	手术≥90 min
脓毒血症组	117(62，196)	01	03	01	01	01	04	02	03.	02
非脓毒血症组	089(70，122)	31	65	28	16	24	54	34	41	51
统计值	Z=-0.431	χ²<0.001		χ²<0.001	-	χ²<0.001	χ²=1.489	χ²=0.004	χ²=0.579	χ²<0.001
P值	0.666	>0.999		>0.999	0.531	>0.999	0.222	0.949	0.447	>0.999

细菌种类	例数
革兰阳性菌
粪肠球菌	8
屎肠球菌	1
表皮葡萄球菌	1
腐生葡萄球菌	1
路邓葡萄球菌	1
无乳链球菌	4
无枝菌酸棒状杆菌	1
革兰阴性菌
大肠埃希菌	50
奇异变形杆菌	13
肺炎克雷伯菌	7
铜绿假单胞菌	6
鲍曼不动杆菌	1
恶臭假单胞菌	1
科泽柠檬酸杆菌	1
摩根摩根菌	1
阴沟肠杆菌	1
真菌
白色假丝酵母菌	2

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