Skip to main content
SpringerLink
Log in

Risk factors for recurrent percutaneous nephrostomy catheter-related infections

  • Original Paper
  • Published:
Infection Aims and scope Submit manuscript

Abstract

Purpose

Percutaneous nephrostomy (PCN) catheters are mainly indicated for urinary tract obstructions. Unfortunately, the rate for infection and recurrence remains elevated. Our objective was to identify the risk factors leading to recurrent PCN-related infections (PCNI) in cancer patients.

Methods

We retrospectively reviewed 571 patients who underwent initial PCN catheter placement at our institution. Of these, we identified patients with a definite PCNI and catheter exchange, with a minimum 30-day follow-up. We defined PCNI as presence of a urine culture positive for bacteria (≥ 104 CFU/mL) plus symptoms of urinary tract infection. A PCNI was considered recurrent if the same organism was isolated. Antibiotics were considered concordant if they were active against all identified organisms.

Results

A total of 81 patients (14%) developed an initial PCNI. Of 47 patients with 30-day follow-up, 10 patients (21%) were identified as having a recurrent PCNI. In terms of demographic characteristics, clinical manifestations, and microbiological data, there was no statistically significant difference between the recurrent and non-recurrent groups. However, in multivariate logistic regression analysis, two factors were independently associated with a decrease in recurrent PCNI: concordant antibiotic use (OR 0.04; p = 0.008) and PCN catheter exchange within 4 days of infection (OR 0.1; p = 0.048).

Conclusions

To decrease the high rate of recurrent infections, associated costs, and potential delay in further chemotherapy, we recommend that once antimicrobial susceptibility test results are available and the patient is known to be receiving concordant antimicrobials, clinicians proceed with immediate PCN catheter exchange, ideally within the first 4 days of the infection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Goodwin WE, Casey WC, Woolf W. Percutaneous trocar (needle) nephrostomy in hydronephrosis. J Am Med Assoc. 1955;157:891–4.

    Article  CAS  PubMed  Google Scholar 

  2. Dagli M, Ramchandani P. Percutaneous nephrostomy: technical aspects and indications. Semin Interv Radiol. 2011;28:424–37.

    Article  Google Scholar 

  3. Ramchandani P, Cardella JF, Grassi CJ, Roberts AC, Sacks D, Schwartzberg MS, et al. Quality improvement guidelines for percutaneous nephrostomy. J Vasc Interv Radiol. 2003;14:277–81.

    Google Scholar 

  4. Donlan RM, Costerton JW. Biofilms: survival mechanisms of clinically relevant microorganisms. Clin Microbiol Rev. 2002;15:167–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Cronan JJ, Marcello A, Horn DL, Robinson A, Dorfman GS, Opal S. Antibiotics and nephrostomy tube care: preliminary observations. Part I. Bacteriuria. Radiology. 1989;172:1041–2.

    Article  CAS  PubMed  Google Scholar 

  6. Pabon-Ramos WM, Dariushnia SR, Walker TG, d’Othee BJ, Ganguli S, Midia M, et al. Quality improvement guidelines for percutaneous nephrostomy. J Vasc Interv Radiol. 2016;27:410–4.

    Article  PubMed  Google Scholar 

  7. McDevitt JL, Acosta-Torres S, Zhang N, Hu T, Odu A, Wang J, et al. Long-term percutaneous nephrostomy management of malignant urinary obstruction: estimation of optimal exchange frequency and estimation of the financial impact of patient compliance. J Vasc Interv Radiol. 2017;28:1036–42 e8.

    Article  PubMed  Google Scholar 

  8. Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, et al. Surgical management of stones: American Urological Association/Endourological Society Guideline, part II. J Urol. 2016;196:1161–9.

    Article  PubMed  Google Scholar 

  9. Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50:625–63.

    Article  PubMed  Google Scholar 

  10. Raz R, Schiller D, Nicolle LE. Chronic indwelling catheter replacement before antimicrobial therapy for symptomatic urinary tract infection. J Urol. 2000;164:1254–8.

    Article  CAS  PubMed  Google Scholar 

  11. Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol. 2010;31:431–55.

    Article  PubMed  Google Scholar 

  12. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315:801–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Skolarikos A, Alivizatos G, Papatsoris A, Constantinides K, Zerbas A, Deliveliotis C. Ultrasound-guided percutaneous nephrostomy performed by urologists: 10-year experience. Urology. 2006;68:495–9.

    Article  PubMed  Google Scholar 

  14. Bahu R, Chaftari AM, Hachem RY, Ahrar K, Shomali W, El Zakhem A, et al. Nephrostomy tube related pyelonephritis in patients with cancer: epidemiology, infection rate and risk factors. J Urol. 2013;189:130–5.

    Article  PubMed  Google Scholar 

  15. Adamo R, Saad WE, Brown DB. Management of nephrostomy drains and ureteral stents. Tech Vasc Interv Radiol. 2009;12:193–204.

    Article  PubMed  Google Scholar 

  16. Venkatesan AM, Kundu S, Sacks D, Wallace MJ, Wojak JC, Rose SC, et al. Practice guidelines for adult antibiotic prophylaxis during vascular and interventional radiology procedures. Written by the Standards of Practice Committee for the Society of Interventional Radiology and Endorsed by the Cardiovascular Interventional Radiological Society of Europe and Canadian Interventional Radiology Association [corrected]. J Vasc Interv Radiol. 2010;21:1611–30 (quiz 31).

    Article  PubMed  Google Scholar 

  17. Talbot TR, Stone EC, Irwin K, Overholt AD, Dasti M, Kallen A, et al. 2017 recommendations on use of chlorhexidine-impregnated dressings for prevention of intravascular catheter-related infections: an update to the 2011 guidelines for the prevention of intravascular catheter-related infections from the Centers for Disease Control and Prevention. https://www.cdc.gov/infectioncontrol/guidelines/bsi/c-i-dressings/index.html. Accessed 3 June 2018.

  18. Vargas-Cruz N, Reitzel RA, Rosenblatt J, Jamal M, Szvalb AD, Chaftari AM, et al. In vitro study of antimicrobial percutaneous nephrostomy catheters for prevention of renal infections. Antimicrob Agents Chemother. 2017;61:AAC-02596.

    Article  Google Scholar 

  19. Viola GM, Rosenblatt J, Raad II. Drug eluting antimicrobial vascular catheters: progress and promise. Adv Drug Deliv Rev. 2017;112:35–47.

    Article  CAS  PubMed  Google Scholar 

  20. Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49:1–45.

    Article  CAS  PubMed  Google Scholar 

  21. Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med. 2004;351:1645–54.

    Article  CAS  PubMed  Google Scholar 

  22. Baddour LM, Epstein AE, Erickson CC, Knight BP, Levison ME, Lockhart PB, et al. Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association. Circulation. 2010;121:458–77.

    Article  PubMed  Google Scholar 

  23. Darouiche RO. Treatment of infections associated with surgical implants. N Engl J Med. 2004;350:1422–9.

    Article  CAS  PubMed  Google Scholar 

  24. Viola GM, Baumann DP, Mohan K, Selber J, Garvey P, Reece G, et al. Improving antimicrobial regimens for the treatment of breast tissue expander-related infections. Plast Reconstr Surg Glob Open. 2016;4:e704.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

UT MD Anderson’s Department of Scientific Publications provided editorial assistance.

Funding

This study was supported in part by funds from The University of Texas MD Anderson Cancer Center, Houston, Texas, and by the National Institutes of Health/National Cancer Institute, under award number P30CA016672.

Author information

Authors and Affiliations

  1. Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1460, Houston, TX, 77030, USA

    Ariel D. Szvalb, Hanine El Haddad, Kenneth V. Rolston, Ying Jiang, Issam I. Raad & George M. Viola

  2. Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Sharjeel H. Sabir

Authors
  1. Ariel D. Szvalb
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hanine El Haddad
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kenneth V. Rolston
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sharjeel H. Sabir
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ying Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Issam I. Raad
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. George M. Viola
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ariel D. Szvalb.

Ethics declarations

Conflict of interest

Dr. Issam I. Raad: financial interest and/or other relationship with Cook Medical. All other authors: no reported conflicts.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Szvalb, A.D., El Haddad, H., Rolston, K.V. et al. Risk factors for recurrent percutaneous nephrostomy catheter-related infections. Infection 47, 239–245 (2019). https://doi.org/10.1007/s15010-018-1245-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-018-1245-y

Keywords

Search

Navigation