Clinical observation and analysis of the risk of post-operative infection complications for endoscopic treatment of upper urinary calculi combined with CRE bacteriuria / 中华泌尿外科杂志

ABSTRACT

Objective:To evaluate the risk of infectious complication after endoscopic surgery for the treatment of upper urinary tract calculi combined with carbapenem-resistant Enterobacteriaceae (CRE) bacteriuria.Methods:The clinical data of 14 patients who were diagnosed with upper urinary tract calculi combined with CRE bacteriuria and treated in Tsinghua University affiliated Beijing Tsinghua Changgung Hospital from January 2015 to December 2019 were analyzed retrospectively. There were 7 males and 7 females, aged from 34 to 71 years old (mean 58.2 years old). The diagnosis was confirmed by ultrasonography, CT or abdominal X-ray. Fourteen cases underwent 15 procedures, including 4 RIRS and 11 PCNL. One patient underwent 2 PCNL procedures at an interval of 1 week, and 1 patient underwent PCNL 16 days after nephrostomy. There were 13 cases of renal calculi and 1 case of upper ureteral calculi. Stones were found on the left side in 8 cases and the right side in 6 cases. There were 3 cases of solitary stone, 4 cases of multiple stones and 7 cases of staghorn stone. The maximum diameter of stones was (31.5±10.2)mm in patients who underwent PCNL, and(10.8±2.6)mm in patients undergoing RIRS. The complete blood count, blood biochemistry, procalcitonin and C-reactive protein were tested postoperatively on the same day of the procedure and 1 day after the procedure. Abdominal X-ray was performed 1-2 days postoperatively, and the ureteral stent (double J) was removed 4 weeks after the procedure. Fourteen patients with CRE bacteriuria underwent 15 endoscopic procedures. Urine culture identified 7 cases of Escherichia coli, 6 cases of Klebsiella pneumoniae and 1 case of Enterobacter cloacae. Preoperative blood culture was performed in 3 cases, of which 1 case was negative and 1 case was Klebsiella pneumoniae positive. Before operation, 11 cases were empirical treated with broad-spectrum antibiotics, including monotherapy in 10 cases and drug combination therapy in 1 case. Sensitive antibiotics against CRE were prescribed in 4 cases preoperatively, including monotherapy in 2 cases and drug combination therapy in 2 cases. Antibiotics were used preoperatively for 1-24 days (mean 7.1 days).Results:After the operation, 7 cases received monotherapy with broad-spectrum antibiotics. Sensitive antibiotics against CRE were prescribed in 4 cases postoperatively, including monotherapy in 4 cases and drug combination in therapy 4 cases. Postoperative antibiotics were used for 2-17 days (mean 6.8 days). There were 3 cases of systemic inflammatory response syndrome (SIRS) after operation, and there were no cases of sepsis, septic shock or death. The main components of stones were ammonium magnesium phosphate hexahydrate in 8 patients and calcium oxalate monohydrate in 6 patients.Conclusions:Effective measures can be taken to reduce or avoid bacteremia caused by CRE, reducing mortality and the use of antibiotics. Endoscopic surgery can be performed only after the clinical symptoms and laboratory tests have significantly improved. Patients with fever and other clinical symptoms and abnormal infectious markers should be treated with targeted antimicrobial therapy.