体外衝撃波結石破砕術後の尿路感染症予防に関する検討

Abstract

ESWLが施行された161例を対象とし, low risk群(133例)とhigh risk群(28例)に分類し, さらに術後感染予防としての薬剤投与の有無と投与方法によって無作為に細分類した。1) Low risk群では, 全体の術後発熱頻度は1.5%と低く, 術後7日目の尿細菌培養陽性率は10.0%であった。術後に抗菌剤OFLXを投与したA群(66例)と無投与であったB群(67例)の間で発熱頻度および尿細菌培養陽性率に差はなかった。2) High risk群全体での術後発熱頻度は21.4%とlow risk群より有意に高く, 術後7日目の尿細菌培養陽性率は24.0%であった。発熱例と患者背景の関係を見たとき, 腎盂腎炎発作の既往とD-Jステント留置例においてとくに発熱頻度が高かった

One hundred and sixty one patients with upper urinary stones were examined for antimicrobial prophylaxis following extracorporeal shock wave lithotripsy (ESWL). They were divided into two groups, the low-risk group (n = 133) and high-risk group (n = 28), according to the risk factors of urinary tract infection. The patients in the low-risk group were further randomized into two groups which were orally given ofloxacin for 7 days after ESWL (Group A, n = 66), no antimicrobial (Group B, n = 67). The patients in the high-risk group were randomly subdivided into three groups which were given flomoxef intravenously for 2 or 3 days and ofloxacin for 4 or 5 days thereafter (Group C, n = 10), flomoxef only for 2 or 3 days and no drugs later (Group D, n = 10), ofloxacin for 7 days (Group E, n = 8). In all of the patients in the low-risk group, during the 7 days after ESWL, fever elevation was observed in only 1.5% of patients, and bacteriuria in 10.0% on the 7th day. There was no difference in frequency of fever elevation and bacteriuria following ESWL between Group A and Group B. These findings indicate that prophylactic antimicrobial after ESWL treatment is not necessary for low risk patients with urinary tract infections. In the high-risk group, the over-all rates of fever elevation and bacteriuria were 21.4% and 24.0% respectively. The difference of effectiveness among the prophylactic regimens of the three groups (Group C, D, E) was not shown.(ABSTRACT TRUNCATED AT 250 WORDS)