Bacteriophage therapy and prevention of infectious and inflammatory complications after endoscopic urologic surgery

Relevance. Given the growing antibiotic resistance of pathogens of urologic infection to antimicrobial drugs, one of the urgent problems is the search for alternative methods of antimicrobial prevention of infectious and inflammatory complications after surgical interventions, as well as an adequate therapy regimen during the postoperative period. Bacteriophage preparation is an alternative method for the treatment and prevention of infectious and inflammatory urological diseases.

Objective. To determine an effective method for preoperative antimicrobial prevention of infectious and inflammatory complications in patients with kidney stones subjected to percutaneous nephrolithotripsy (PNLT).

Methods. The study included 90 patients with coralloid or multiple large kidney stones who underwent PNLT. Before PNLT, all patients underwent bacteriological urinalysis in order to determine sensitivity not only to antibiotics and bacteriophage preparations. Urine sampling was performed for further microbiological cultural examination during renal pelvic puncture on the 3rd and 7th days after PNLT. Depending on the technique of perioperative prophylaxis, three groups of 30 were formed. Group 1 patients were intravenously injected with 1000 mg of ciprofloxacin throughout the operation and then intravenously dipped with 1000 mg once a day for 3–5 days. Group 2 received intramuscular cefotaxime + sulbactam (1.0+0.5) twice a day 2 h before surgery intramuscularly once. In group 3, patients received oral mycobacteriophage 40 ml polyvalent purified orally 1 h before surgery and 40 ml orally 3 times a day for 3–5 days after surgery.

Results. In all three groups, the development of infectious complications in patients was assessed: acute pyelonephritis, systemic inflammatory reaction syndrome (SERS) or urosepsis. No serious infectious or inflammatory complications were observed in any group during the early postoperative period. The development of CVD after PNLT was noted on the 1st–3rd postoperative day (in 26.6 %, 20 and 20 % of patients of the 1st, 2nd and 3rd groups, respectively). However, on the 4th–7th day after PNLT, normal blood parameters (leukocytes, rod-shaped neutrophils), temperature, and general well-being were noted.

Conclusion. The same effectiveness of different antimicrobial regimens for preventing infectious and inflammatory complications after PNLT was similar. Bacteriophage preparations are effective and can prevent infectious and inflammatory complications following PNLT. The development of CVD after PNLT on the 1st–3rd day after surgery cannot be correlated only with the antimicrobial drugs used and the method of their administration (intravenously, intramuscularly and orally). Most likely, the development of CVD is associated with operational injury.

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