缩小知识差距:输尿管支架抗生素使用的过去、现在和未来。

IF 3.7 2区 医学 Q1 UROLOGY & NEPHROLOGY BJU International Pub Date : 2024-09-04 DOI:10.1111/bju.16515
Jasper Cornette, Dirk Lange, Ben H. Chew, Thomas Tailly
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引用次数: 0

摘要

目的:评估输尿管支架相关感染、抗生素使用和细菌定植方面的现有文献:评估有关输尿管支架相关感染、抗生素使用和细菌定植的现有文献,以确定目前支架相关感染的发生率,揭示知识差距,并为未来研究提出潜在假设:方法:利用PubMed、Cochrane和泌尿外科协会网站进行文献综述,确定1983年至2024年1月期间发表的相关英文文献:结果:全世界范围内都缺乏关于支架置入、更换或拔出时抗生素预防的指南。对于接受输尿管镜检查和支架置入术前尿液培养阴性的患者,可以考虑仅在存在风险因素的情况下进行预防。不过,对于支架置入前的患者,术前尿培养对于指导输尿管内手术的预防非常重要。在支架植入期间,抗生素预防在预防尿路感染(UTI)方面没有任何优势。没有有力的证据支持在移除支架时使用抗生素。在缺乏明确证据的情况下,治疗输尿管支架患者尿路感染的策略存在很大差异。可以考虑更换支架,以清除作为潜在细菌来源的生物膜。在感染期间,支架培养有助于指导治疗,因为尿液培养和支架培养可能有所不同:就抗生素管理而言,泌尿科医生应意识到不必要使用抗生素会引发细菌耐药性。我们亟需在抗生素预防和支架相关感染领域开展进一步研究,以获得有助于为这一泌尿外科常见病制定明确指南的证据。
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Bridging the knowledge gap: past, present and future of antibiotic use for ureteral stents

Objective

To evaluate the available literature on ureteric stent-related infections, the use of antibiotics and bacterial colonisation to identify the current incidence of stent-related infections, unveil knowledge gaps and generate potential hypotheses for future research.

Methods

A literature review was conducted using PubMed, Cochrane and urological association websites identifying relevant English literature published between 1983 and January 2024.

Results

There is a worldwide lack of guidelines for antibiotic prophylaxis for stent placement, exchange or extraction. In patients with a negative preoperative urine culture undergoing ureteroscopy and stent placement, it may be considered to only provide prophylaxis in presence of risk factors. However, in pre-stented patients a preoperative urine culture is important to guide prophylaxis during endourological surgery. During stent indwell time, antibiotic prophylaxis does not show any advantage in preventing urinary tract infections (UTIs). There is no strong evidence to support the use of antibiotics at time of stent removal. In the absence of any clear evidence, management strategies for treating UTIs in patients with ureteric stents vary widely. Stent exchange could be considered to remove the biofilm as a potential source of bacteria. Stent culture can help to guide treatment during infection as urine culture and stent culture can differ.

Conclusion

In terms of good antibiotic stewardship, urologists should be aware that unnecessary use of antibiotics provokes bacterial resistance. There is a great need for further research in the field of antibiotic prophylaxis and stent-related infections to develop evidence that can help shape clear guidelines for this very common urological practice.

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来源期刊
BJU International
BJU International 医学-泌尿学与肾脏学
CiteScore
9.10
自引率
4.40%
发文量
262
审稿时长
1 months
期刊介绍: BJUI is one of the most highly respected medical journals in the world, with a truly international range of published papers and appeal. Every issue gives invaluable practical information in the form of original articles, reviews, comments, surgical education articles, and translational science articles in the field of urology. BJUI employs topical sections, and is in full colour, making it easier to browse or search for something specific.
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