Discussion
pyuria, pneumonia, postoperative pulmonary complications, infections, post-traumatic chest, bronchitis, bacterial infections, UTIs
PNEUMONIA, POSITIVE, TRACHEOBRONCHITIS, COMPLICATED URINARY TRACT INFECTION, INFECTIONS, CYSTIC FIBROSIS, BRONCHITIS, NOSOCOMIAL INFECTIONS, UTI, ADVERSE REACTION, BACTERIAL INFECTIONS
The utilization of ureteral stents in urological practice has seen a notable increase in recent years. Unfortunately, the presence of these stents contributes to the formation of biofilms. Extensive research has demonstrated that biofilms, primarily formed by microorganisms, are responsible for approximately 65% of nosocomial infections. As the use of stents continues to rise, so does the incidence of complicated urinary tract infections (UTIs) [Bacterial colonization of the stent plays a crucial role in the development of stent-related infections [N-acetylcysteine (NAC) is a widely used medication for the treatment of paracetamol overdose and as a compound that helps to break down mucus. It has a well-established safety record and is approved for use in conditions characterized by abnormal, thick, or sticky mucus secretions, such as pneumonia, bronchitis, tracheobronchitis, cystic fibrosis, patients with tracheostomies, postoperative pulmonary complications, post-traumatic chest conditions, and as a preparation before diagnostic bronchoscopy to alleviate mucus blockage. NAC replenishes glutathione reserves by providing cysteine, an essential building block for glutathione production. In addition, NAC has the ability to bind to toxic metabolites and scavenge free radicals. It also enhances oxygen delivery to tissues, increases the production of mitochondrial ATP, and modulates microvascular tone to improve blood flow and oxygen supply to the liver and other vital organs.In a study by Pérez-Giraldo et al., it was reported that N-acetylcysteine, protamine sulfate, Bandazac lysine, and sodium salicylate demonstrated the ability to reduce or hinder bacterial adherence and disrupt established biofilms [No clinical studies have been published discussing the effect of the combination of NAC and an antibiotic on biofilm formation and bacterial adherence on ureteral stent surfaces. However, El-Feky et al. and El-Rehewy et al. in 2009 published in vitro studies on the effect of ciprofloxacin and NAC on bacterial adherence and biofilm formation [Our study is an in vivo study comparing the effect of oral NAC and co-trimoxazole alone and in combination on bacterial adherence and biofilm formation. Co-trimoxazole was chosen as the antibiotic of choice due to its composition of trimethoprim (TMP) and sulfamethoxazole. These two drugs target different steps in the pathway of an essential enzymatic reaction in bacteria. As a result, their combined action exhibits a synergistic effect, enhancing their effectiveness against bacterial infections [After 2 weeks of treatment, urinalysis revealed that 72.7% of the control group had significant pyuria, which matches the results of Pooli et al. [Urine culture of the patients revealed that 38.8% of the control group were positive. This poor correlation between positive findings on urinalysis and positive urine culture in patients with indwelling stents suggests that urine culture is necessary to diagnose UTI. This also matches the results of Pooli et al. [Regarding stent culture Positive stent cultures were found in 63.6% (105/165), 43.1% (66/153), 37% (60/162), and 19.2% (30/156) patients of groups A, B, C, and D, respectively. close to the results of El-Feky et al. and El-Rehewy et al. [In our study, a distinction exists between urine culture and stent culture positivity. Our study revealed that the rate of positive stent culture was higher than that of positive urine culture across the groups. In addition, all patients with positive urine culture also had positive stent cultures. Among the patients with positive urine culture, we observed that the type of bacteria identified was consistent with the bacteria found in the stent culture. Furthermore, in certain cases, we identified different types of bacterial colonies on the stents compared to those found in the urine culture of the same patient, although all the bacteria types detected in the urine culture were also present in the stent culture.Adverse reaction of drugs of each group was mild and self-limited as hypersensitive patients to drugs used was excluded from the study (Table While both oral NAC and oral co-trimoxazole can have a role in reducing bacterial adherence and biofilm formation on ureteral stent surfaces, the combination of both has a greater effect on reducing bacterial adherence and biofilm formation on these surfaces.