上段輸尿管結石併尿路敗血症患者放置經皮腎造廔管後: 經過多久的抗生素療程適合接受輸尿管碎石手術？

徐任廷¹、鐘旭東¹、鄭百諭¹

¹亞東紀念醫院 外科部 泌尿科

In Patients with Upper Ureteral Stones and Urosepsis Post-PCN: How many days of antibiotic treatment are sufficient to proceed with URSL?

Jen-Ting Hsu¹ , Shiu-Dong Chung¹, Pai-Yu Cheng,¹

Division of Urology¹ Department of Surgery, Far Eastern Memorial Hospital, New Taipei City

Purpose: Urosepsis is a severe, potentially life-threatening condition often caused by ureteral stones. Standard treatment includes percutaneous nephrostomy (PCN) and broad-spectrum antibiotics, with ureteroscopic lithotripsy (URSL) for stone removal performed once the infection stabilizes. This study aims to determine the appropriate duration of antibiotic treatment required before proceeding with URSL in patients with urosepsis from upper ureteral stones following PCN drainage.

Materials & Methods

From 2013 to 2019, we enrolled 107 patients with upper ureteral stones complicated by urosepsis and fever (≥37.5°C). The choice of empirical antibiotics and treatment duration prior to URSL were based on the physician’s experience and clinical conditions. Patients were divided into two groups based on post-URSL fever, and we compared them by age, gender, stone location, max stone length, urine and blood cultures, and duration of antibiotic treatment. We also measured the time from PCN to URSL and the length of hospitalization following URSL

Results

Demographic characteristics, including age, gender, stone location, and maximum stone length, were similar between the two groups. Escherichia coli was the most commonly isolated bacterial organism in both groups. The duration of antibiotic treatment was 7.1 days in the afebrile group and 5.7 days in the febrile group (p=0.022). The time from PCN to URSL was longer for the afebrile group (5.8 days) compared to the febrile group (4.3 days, p=0.004). Additionally, the afebrile group had fewer hospitalization days post-URSL (3.1 days vs. 5.3 days, p=0.015).

Conclusions

In patients with urosepsis from upper ureteral stones who have undergone percutaneous nephrostomy (PCN), a 7 to 8-day course of antibiotics can prevent post-URSL fever and shorten hospital stays after surgery.