健康成人接受經尿道輸尿管鏡相關手術使用不同種類之預防性抗生素與安慰劑，術後感染情形之比較
陳採風、李苑如1
天主教耕莘醫院新店總院 外科部 泌尿科；國立台灣大學附設醫院 泌尿部1
Comparison of the post-operative infection by using different type of prophylactic antibiotics and placebo in healthy adult patients who underwent ureterorenoscopic surgery
sai-Feng Chen, Yuan-Ju Lee1,
Division of Urology, Department of Surgery, Cardinal Tien Hospital and Fu-Jen Catholic University, Taipei, Taiwan. Department of Urology, National Taiwan University Hospital, Taipei, Taiwan1
Purpose:
To compare the efficacy of prophylactic antibiotics in reduction of
post-operative infections in patients undergoing ureterorenoscopy (URS) as the intervention.
Materials and Methods:
The study is a open-labeled, prospective, randomized controlled trial. Between 2013 to 2014, 63 patients with preoperative sterile urine undergoing URS were randomly and eqully allocated by the randomization to three groups, and each group received prophylactic antibiotics with single-dose intravenous cefazolin (1gm), oral cefuroxime (500mg) or placebo (control group), respectively. The Urine analysis and urine cultures were obtained around postoperative day 5 to 7. We defined pyuria as WBC≧ 10/HPF at urine sediment study, and significant bacteriuria was defined as ≧105 CFU pathogens/ml in the urine.. Febrile urinary tract infection (fUTI) was defined as body temperature more than 38 Celsius degree with pyuria or significant bacteriuria within 7 days post-operatively.
Results:
Total 61 patients were recruited for the analysis. The postoperative pyuria were significantly lower in patients with prophylaxis than the placebo group. Patients receiving prophylactic antibiotics with cefazolin and oral cefuroxime were subjected to significantly lower risks of pyuria compared with the control group (23.8% and 30% vs. 60.%, p<0.05).
There are the trends that the rate of bacteriuria was lower in patients underwent prophylaxis, though it was not statistically significant (12.2% vs 30%, p=0.15) There was no significant difference in rate of fUTI between patients with abx prophylaxis and the placebo group. (1% vs. 0%, p=1).
Conclusions:
Antibiotic prophylaxis significantly reduces the incidence of
pyuria following URSL and tends to decreased the risk of bacteriuria.