体外衝撃波結石破砕治療における予防的抗菌剤投与の必要性の有無

Abstract

1992年5月12日から9月30日までの間に国立大阪病院泌尿器科でMPL 9000(X線装置付き)によりESWL治療を行った患者のうち, 治療前に感染結石ではないと判断され, 治療前後に抗菌剤の投与を行わなかった28名の片側性上部尿路結石症患者を対象に, 予防的な抗菌剤の投与の必要性の有無につき検討した。1)ESWL治療における予防的な抗菌剤の投与は, たとえESWL治療前に膿尿(尿中白血球数≧10個/hpf)を呈していても不要である。2)ESWL治療における尿中細菌培養検査は, 菌の同定および薬剤感受性テストが可能な102CFU/ml以上を陽性として検索すべきであり, またESWL治療直後の尿中細菌を検索することが, 後に感染症を合併した時の早期治療のために必要である

We examined whether prophylactic antibiotics are necessary or not during the ESWL treatment for patients with urolithiasis. Twenty-eight patients with unilateral renal or ureteral stones composed of calcium oxalate, calcium phosphate or the mixed stones were treated with MPL 9000 between May 12 and September 30, 1992. Although 17 patients (60.7%) had complications of pyuria before treatment, none of the 28 patients had taken any prophylactic antibiotics during the treatment. To evaluate the clinical signs of infection, we examined the white blood cell count, in blood and urine sediment and serum C-reactive protein (CRP) value at the time of 1, 3 and 7 days after ESWL treatment, and body temperature and urine culture at the time immediately after the treatment in addition to the above-mentioned days, compared with the pre-treatment data. White blood cell count at one day after ESWL treatment was significantly elevated both in the patients with and without pyuria, while body temperature at the time immediately after the treatment was significantly elevated only in the patients with pyuria. Six of the 23 patients (26.1%) with preoperative sterile urine and who had urine culture immediately after ESWL, had bacteriuria. However, none of the 28 patients had any clinically significant infectious complications during ESWL treatment without any antibiotics therapy. We concluded that it is important to examine urine culture immediately after ESWL treatment for early protection from complication of urinary tract infection and that administration of prophylactic antibiotics is not necessary during ESWL treatment for patients with non-infection stones even concomitantly with pyuria.