Analysis Of Bacterial Spectrums In Urine Cultures Of Patients With Upper Urinary Stones Before Operations And The Uses Of Antibiotics

Background and Objective:Urinary tract calculi is one of the common diseases of urinary system, the morbidity is1%～5%in China. With the rapid development of economy and the change of dietary structure, the trend of morbidity of urinary tract calculi is still rising year by year. Urolithiasis can be classified as upper urinary tract stones and lower urinary tract stones, and about80%is upper urinary tract stones. Percutaneous nephrolithotomy and Ureteroscopic lithotripsy are prefered therapy of upper urinary tract stones what have improve the security and efficacy, but urinary sepsis of postoperative can not be avoided completely. Many researches reported that postoperative SIRS is related to the level of WBC in the urine, operative time, access, flushing fluid and transfusion. Rearches about analysis of bacterial spectrums in urine culture and the use of antibiotics are still less. Widely and irrational uses of antibiotics result in more drug resistance.Methods:Retrospective analysis of clinical datas of143cases who underwent the operations of upper urinary lithiasis from January2012to July2013in tianjin medical university general hospital. All cases of preoperative took the middle urine bacteria cultures and the antibiotic prophylaxis. Supervising the body temperature, heart rate, respiration, WBC. To analyse the spectrums in middle urine cultures and the uses of antibiotics of upper urinary stones. To analysis the influence of urine culture and days of antibiotics prophylactic treatment to SIRS of postoperative.Results:143cases of patients, midstream urine culture positive was58cases(40.56%),26cases(18.18%) of postoperative SIRS occured, with the positive urine culture, gram-negative bacteria infection was45cases(77.59%), gram-positive bacteria infection was13cases(22.41%). There were30strains(51.72%) of Escherichia coli, they got high sensitivity to p-lactamase inhibitor and cefoxitin. There were8strains(13.79%) of Enterococcus faecalis,the antimicrobial sensitivity rates of E. Faecalis to nitrofurantoin and ampicillin were100%and87.5%, respectively. No strains of E. faecalis or E. faecium resistant to vancomycin and teicoplanin were found. The chi-square analysis showed that preoperative midstream urine culture positive and antibiotics prophylaxis treatment<3days are significantly related with postoperative SIRS(P<0.05), female and stag horn stones are significantly related with urine culture positive(P<0.05).Conclusion: Urolithiasis acompanied with UTI is a common disease. Stone, obstruction and hydronephrosis can make a vicious circle. Most of the strains are gram-negative bacteria for preoperative midstream urine cultures, β-lactamase inhibitor and cefoxitin can be used for experiential antibiotic therapy. Erythromycin, clindamycin, tetracycline and quinolone can not be used as the first choice for antibiotic therapy. Urine culture positive before the operation and use of antibiotics prophylaxis treatment less than3days are the risk factors of postoperative SIRS. Preoperative midstream urine bacteria culture and choose sensitive antibiotics prophylaxis treatment≥3according to the antimicrobial susceptibility test results have great meaning to prevent SIRS after the lithotripsy.