Efficacy of fosfomycin in preventing infection after endoscopic combined intrarenal surgery in periods of limited supply of first‐ and second‐generation cephalosporins
Efficacy of fosfomycin in preventing infection after endoscopic combined intrarenal surgery in periods of limited supply of first‐ and second‐generation cephalosporins
复制标题
磷霉素在一、二代头孢菌素供应有限时期预防内镜肾内联合手术后感染的效果
DOI：
10.1111/iju.14896
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发表时间：
2022
影响因子：
2.6
通讯作者：
Yasui Takahiro
中科院分区：
文献类型：
--
作者：
Etani Toshiki;Asaoka Minami;Kondo Shuhei;Wachino Chiharu;Tomiyama Nami;Hattori Tatsuya;Nagai Takashi;Iida Keitaro;Taguchi Kazumi;Naiki Taku;Hamamoto Shuzo;Okada Atsushi;Kawai Noriyasu;Yanagita Takeshi;Nakamura Atsushi;Yasui Takahiro
目的2019年3月，头孢唑林因活性成分采购困难而缺货。此外，诸如头孢替安和头孢美唑等替代药物的供应有限。在肾泌尿科，以磷霉素为基础的药物被用作围手术期预防性抗菌药物头孢唑林的替代品。本文对磷霉素钠联合头孢替安预防内镜联合肾内手术后感染的有效性进行回顾性初步研究。方法选取2017年8月至2021年1月在我科行内窥镜联合肾内手术的患者200例。患者采用头孢替安（n= 95）或磷霉素（n= 105）作为围手术期抗菌药物。头孢替安组和磷霉素组的中位年龄和手术时间没有显著差异。进行倾向评分匹配，以匹配两组术前尿细菌计数。每组选择68例患者。结果两组患者术后平均住院时间均为4 d。术后中位最高温度分别为37.5°C和37.4°C。两组患者术后最高温度无显著差异。此外，两组之间在白细胞计数、C反应蛋白水平、术后天冬氨酸转氨酶和丙氨酸转氨酶水平以及需要额外抗生素的术后发热方面没有差异。结论：在一段难以获得头孢唑林和头孢替安的时期，使用磷霉素使我们能够继续治疗，而没有增加临床并发症。
ObjectivesIn March 2019, cefazolin was unavailable owing to difficulty in procuring the active ingredient. Furthermore, the supply of alternative drugs, such as cefotiam and cefmetazole, was limited. In the Department of Nephro‐Urology, fosfomycin‐based drugs are used as substitutes for cefazolin, which is a perioperative prophylactic antibacterial drug. Herein, we investigated the effectiveness of fosfomycin sodium and cefotiam in preventing infection after endoscopic combined intrarenal surgery as a retrospective preliminary study.MethodsA total of 200 patients who underwent endoscopic combined intrarenal surgery at our department between August 2017 and January 2021 were included. The patients were administered cefotiam (n= 95) or fosfomycin (n= 105) as perioperative antibacterial agents. There were no significant differences in the median age or surgery time between the cefotiam and fosfomycin groups. Propensity score matching was performed to match the preoperative urine bacterial counts of both groups. Sixty‐eight patients were selected from each group.ResultsThe median postoperative hospital stay duration was 4 days for the two groups. The median maximum postoperative temperatures were 37.5 and 37.4°C, respectively. There were no significant differences between the maximum postoperative temperatures in both groups. Furthermore, there were no differences between the groups regarding the white blood cell counts, C‐reactive protein levels, and aspartate aminotransferase and alanine aminotransferase levels postoperatively, as well as in terms of postoperative fever requiring additional antibiotics.ConclusionsDuring a period of difficulty in acquiring cefazolin and cefotiam, the use of fosfomycin allowed us to continue with the procedure without increased clinical complications.