TREATMENT OF A PATIENT WITH BILATERAL UROLITHIASIS: CASE REPORT

Abstract

The Global Prevalence of Infections in Urology Study showed that 10-12% of patients in urological departments develop nosocomial infection. Material and methods. Patient U., 47 years old, underwent two-stage minimally invasive percutaneous nephrolithotripsy (MIP) on both sides. The urine bacteriological analysis using sector seeding method on a nutrient medium (nutrient agar, 5% blood agar, sugar broth) revealed Klebsiella pneumoniae 107 CFU / ml, with sensitivity to gentamicin, amikacin, meropinem, norfloxacin, bacteriophages: piobacteriophage complex, klebsiellosis polyvalent. Before the first stage, pre-stenting and antibiotic therapy with norfloxacin 400 x 2 per day for 10 days were performed. After that the MIP was made. The second stage of MIP on the right side was to be performed in 1.5 months. A day before operation antibiotic prophylaxis with amikacin 500 mg x 2 per day was made.Results and discussion. The time of the first operation was 65 minutes. The blood loss was 150 ml. The patient was discharged on the fifth day for outpatient treatment with continued antibiotic therapy gentamicin 80 mg x 2 times a day for 5 days. The operation time of the second stage was 100 minutes. The blood loss was 300 ml. An inflammatory reaction of subcutaneous fat in the area of the postoperative wound developed due to antibiotic resistance. This was stopped by local use of antiseptics ( 0.5% alcohol solution of chlorhexidine). The patient was discharged on day 14 for outpatient follow-up. The ureteral stent was removed in ambulatory after 2 week treatment. A distinctive feature of this case was the tendency to antibiotic resistance in the patient against the background of two-stage treatment of bilateral urolithiasis.Conclusion. The use of MIP allows to get rid of kidney stones of any renal part and it is the standard surgery treatment for urolithiasis. The increasing trends for antibiotic resistance requires more deep preparation of patients before operation and using antibiotics that are sensitive to the urine culture.