Андрология и генитальная хирургия (Nov 2017)
ANTIBACTERIAL PREVENTION OF INFLAMMATORY COMPLICATIONS IN INTERVENTIONAL URORADIOLOGY
Abstract
Introduction. Hospital strains of microorganisms are characterized by multiple drug resistance, which significantly complicates treatment of infectious and inflammatory diseases acquired by patients during hospitalization, especially in the postoperative period. One of the methods of decreasing the level of hospital-acquired urinary tract infections (HAUTI) in urological in-patient facilities is antibacterial prevention prior to various interventions and surgeries.The study objective is to investigate the effectiveness of pre- and postoperative use of fluoroquinolones in prevention of inflammatory complications of interventional and focal treatment methods in uro-andrology.Materials and methods. The study included 32 patients aged 18 to 70 years (mean age 48.9 ± 12 years). All patients received antibacterial prevention in the pre- and postoperative periods. The patients were divided into 3 groups. In the 1st group (n = 10), all patients underwent prostate biopsy, including transrectal multifocal biopsy in 5 patients, template biopsy in 3 patients, and fusion biopsy in 2 patients. In the 2nd group (n = 12), all patients underwent prostatic artery embolization for benign prostatic hyperplasia and intermediate-to-severe lower urinary tract symptoms. In the 3rd group, 10 patients with nephrolithiasis underwent nephrolithotomy without retrograde pyelography.Results. In the 1st group, mean patient age was 66 ± 5.4 years (59–78 years); total score per the International Scoring Prognostic System (IPSS) was 18.7 ± 3.4; mean leukocyte count was 3.2 ± 1.1 per field of vision (FOV); score per the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) for evaluation of chronic prostatitis/chronic pelvic pain syndrome was 19.3 ± 5.7; score per the visual analog scale (VAS) was 4.3 ± 1.2. In 7 patients (70 %), prostate fluid (PF) contained more than 10–15 leukocytes per FOV, in 3 patients (10 %) less than 10 leukocytes. Positive inoculations were observed in 6 patients, Enterobacteriaceae family microorganism sensitivity (microbial count 105 CFU/ml) – in 2, E. сoli sensitivity (105) – in 2, Staphylococcus aureus sensitivity (104) – in 2; the rest of inoculations were negative. PF examination revealed 10–15 leukocytes per FOV in 4 patients, less than 10 leukocytes in 5 patients. In the 2nd group, PF inoculations demonstrated the following positive reactions: E. сoli (104) in 3 patients, Staphylococcus aureus (104) in 2 patients; in other inoculations no microflora growth was observed. No inflammatory complications in the postoperative period were evident. Macrohematuria developed in 3 patients, transient blood in stool in 2 patients. In the postoperative period, there weren’t any data on the presence of flora from patients. The 3rd group included 6 men and 4 women with nephrolithiasis (aged from 34 to 58 years, mean age 47 ± 7.4 years), who underwent percutaneous nephrolithotomy. The patients displayed various concrements in the kidneys (2 recurrent) and ureter. In most patients (8), leukocyturia was diagnosed: from 15 leukocytes per FOV to “dense, whole FOV”; positive inoculations in 7 patients; flora sensitivity to Lefokcin in 5 patients; Enterobacteriaceae family microorganism sensitivity (105) – in 2, E. сoli sensitivity (105) – in 2, Staphylococcus aureus sensitivity (104) – in 1; no microflora growth was observed in other inoculations.Conclusion. Treatment effectiveness in the studied groups was associated with eradication of the causative agent (empirical antibacterial therapy with correction after inoculation (fluoroquinolones), high safety profile, inhibiting concentration in the urologic organs (hematoprostatic and hematotesticular barriers) [1], wide spectrum of action, low probability of development of torpid forms of causative agents, and low level of side effects (hepatotoxicity, effect on spermatogenesis)). Empirical therapy, i.e. treatment until acquirement of microbiological data for a certain patient, plays a crucial role in treatment of urogenital infections. Choice of starting regimen of antibacterial therapy must be based on the local microbiological monitoring data and take into account the spectrum of urinary infection causative agents and their resistance to antibiotics. On the pharmaceutical market, levofloxacin is represented by several drugs, one of which is Lefokcin manufactured by Shreya Life Sciences. It’s an effective antibacterial drug for prevention and postoperative management of patients who underwent interventional and focal diagnostic and treatment procedures of uro-andrology.
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