We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
The impact of nephrostomy drainage prior to mini-percutaneous nephrolithotomy in patients with ESBL-positive Escherichia coli.
- Authors
Zhao, Zhijian; Wu, Wenqi; Zeng, Tao; Wu, Xiangkun; Liu, Yongda; Zeng, Guohua
- Abstract
Objective: Extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) is one of the most frightening multidrug-resistant bacteria that usually causes sepsis. Herein we explored the benefits of nephrostomy drainage prior to percutaneous nephrolithotomy (PCNL) on infection outcomes in patients with ESBL-EC. Patients and methods: Between June 2016 and April 2019, 43 consecutive patients with ESBL-EC who received nephrostomy drainage for > 24 h prior to PCNL were retrospectively evaluated as group 1. 86 patients were randomly selected from patients with ESBL-EC who received concurrent percutaneous access during PCNL as group 2. The postoperative infection complications were compared. Results: Although the total infection complications were not statistically different (11.6% vs. 25.6%, p = 0.066), the severity seemed to be worse among group 2 subjects. Severe infections, including urosepsis (4.7% vs.13.9%) and septic shock (2.3% vs 4.6%), were observed at twice or greater rates in group 2. Blood transfusions were also more frequent (2.3% vs. 13.9%, p = 0.039). Multivariate analysis demonstrated that preoperative drainage was an independent risk factor for postoperative infection events (OR 2.31 CI 1.14–3.48, p = 0.017). Subgroup analyses indicated that preoperative drainage may largely reduce the incidence of urosepsis in patients with hydronephrosis or without receiving preoperative carbapenem therapy. Conclusion: Because of the high rate of severe infection after PCNL in patients with ESBL‑positive E. coli, preoperative nephrostomy drainage for > 24 h is an effective measure to reduce the risk of severe infection complications, especially in patients with hydronephrosis or those without preoperative carbapenem therapy.
- Subjects
NEPHROSTOMY; ESCHERICHIA coli; HYDRONEPHROSIS; PREOPERATIVE risk factors; DRAINAGE; PERCUTANEOUS nephrolithotomy; SEPTIC shock
- Publication
World Journal of Urology, 2021, Vol 39, Issue 1, p239
- ISSN
0724-4983
- Publication type
Article
- DOI
10.1007/s00345-020-03155-6