使用抗生素在尿培养阴性、尿高倍镜下白细胞阳性肾结石患者PCNL术后感染的作用

The Effect of Antibiotics on Postoperative Infection in PCNL Patients with Negative Urine Culture and Positive White Blood Cells under High Magnification Urine Microscopy

摘要: 目的：探讨使用抗生素在尿培养阴性、尿高倍镜下白细胞阳性肾结石患者PCNL术后感染的作用。方法：2021年5月至2022年10月期间在海南医学院第一附属医院泌尿外科拟行一期PCNL治疗且尿培养阴性、尿高倍镜下白细胞 ≥ 10个/视野的肾结石患者共100例参与该项前瞻性随机对照试验，按随机抽签的方法1:1随机入组，两组依据术前不同抗生素使用方案分为多剂量组和单剂量组。多剂量组：术前3天治疗性使用头孢美唑钠1.0 g，一天两次，静脉点滴；单剂量组：术前3天不予抗生素治疗；两组均在术前30分钟预防性使用头孢美唑钠1.0 g，一次，静脉点滴。前瞻性统计分析两组患者病例资料，评价使用抗生素对尿培养阴性、尿高倍镜下白细胞阳性患者PCNL术后感染的作用。结果：将符合纳入标准的100例患者按随机抽签的方法1:1随机入组。其中30例患者被排除出组，最终总计70例患者被纳入研究，多剂量组38例，单剂量组32例。两组间性别、年龄、BMI、既往手术史、结石类型、结石位置、结石直径、肾积水程度，差异均无统计学意义(P > 0.05)；两组间术前血白细胞、血红蛋白、中性粒比率、hs-CRP、PCT、血肌酐、血尿酸、镜下白细胞，差异均无统计学意义(P > 0.05)；两组间术后血红蛋白下降程度、血肌酐、肾盂尿培养、结石清除率、手术时间、术后住院时长，差异均无统计学意义(P > 0.05)。两组间术后血白细胞、中性粒比率、hs-CRP、PCT、发热率、平均体温、心率、SIRS发生情况，差异均有统计学意义(P < 0.05)，其中多剂量组无患者发生SIRS，单剂量组4例(12.5%)发生SIRS，4例患者经系统规范治疗后，均已痊愈出院，未进一步进展为尿源性脓毒血症。结论：对于排除相关高危因素，尿培养结果阴性、尿高倍镜下尿白细胞 ≥ 10个/视野的肾结石患者，PCNL术前使用抗生素3天能够有效预防术后泌尿道感染及SIRS发生。

Abstract: Objective: Explore the effect of antibiotics on postoperative infection in PCNL patients with negative urine culture and positive white blood cells under high magnification urine microscopy. Methods: From May 2021 to October 2022, 100 patients with renal stones who were scheduled for primary PCNL treatment at the First Affiliated Hospital of Hainan Medical College, who had a negative urine culture but had ≥10 white blood cells/high power field in urine microscopy, participated in this prospective randomized controlled trial. Patients were randomized at a 1:1 ratio using a lottery method, divided into multi-dose and single-dose groups based on preoperative antibiotic regimens. The multi-dose group received cefmetazole sodium 1.0 g twice daily intravenously for three days preoperatively, while the single-dose group received no antibiotic treatment three days preopera-tively. Both groups received a prophylactic dose of cefmetazole sodium 1.0 g intravenously 30 minutes before surgery. A prospective statistical analysis of the patient data from both groups was conducted to evaluate the impact of different antibiotic dosages on postoperative infections in pa-tients with PCNL who had a negative urine culture but positive white blood cells in high-power field urine microscopy. Results: Out of 100 patients meeting the inclusion criteria, they were randomized at a 1:1 ratio using a random lottery method. Thirty patients were excluded, and a total of 70 pa-tients were enrolled in the study, 38 in the multi-dose group and 32 in the single-dose group. No statistically significant differences were found between the two groups in terms of gender, age, BMI, previous surgical history, stone type, stone location, stone diameter, and degree of hydronephrosis (P > 0.05). Similarly, no significant differences were identified between the groups regarding pre-operative white blood cells, hemoglobin, neutrophil ratio, hs-CRP, PCT, blood creatinine, uric acid, and microscopic white blood cells (P > 0.05). Postoperative parameters such as hemoglobin decline, blood creatinine, renal pelvis urine culture, stone clearance rate, surgical time, and postoperative hospital stay also showed no statistical significance between the groups (P > 0.05). However, differ-ences in postoperative white blood cells, neutrophil ratio, hs-CRP, PCT, fever rate, average body temperature, heart rate, and incidence of SIRS were statistically significant between the groups (P < 0.05). Notably, no patients in the multi-dose group developed SIRS, while 4 cases (12.5%) in the single-dose group did. All four patients fully recovered after standardized treatment and were dis-charged without progressing to urosepsis. Conclusion: For patients with kidney stones who exclude relevant high-risk factors, have negative urine culture results, and have urine white blood cells ≥ 10 per field under high-power microscopy, using antibiotics for 3 days before PCNL surgery can effec-tively prevent postoperative urinary tract infections and SIRS.