Abstract
The purpose of this study was to compare the postoperative course of patients with positive stone culture (SC) to patients with sterile SC, and to analyze the predictors for post percutaneous nephrolithotomy (PCNL) sepsis; and to describe the type and resistance patterns of bacteria responsible for post PCNL sepsis. From a cohort of 206 consecutive patients undergoing PCNL, we identified 45 patients with a positive SC (group A) and compared them to patients with a sterile SC (group B). Association between different groups was assessed using Chi square, two-tailed Student’s t test and Mann–Whitney U test, as appropriate. Twenty-three patients had postoperative sepsis and regression analysis was performed to identify clinical variables associated with sepsis. Demographics, stone load and hospitalization time were similar in both groups. Postoperative sepsis developed in 31.1 % of patients in group A compared to 5.9 % in group B. In multivariate analysis, only positive SC was an independent risk factor for postoperative sepsis (OR 6.894, 95 % CI 2.31–20.59, P = 0.001). All patients responded well to treatment with no septic complications. Enterococci were the prevalent organism (29.4 %) in patients with a positive SC. Quinolone resistance was high in both gram negative and gram positive bacteria. Patients with an infected stone are at high risk to develop postoperative sepsis despite standard preoperative antibiotic preparation. SC is important to direct further treatment as almost half of patients with positive SC have a discordant or sterile urine culture. Determining the prevalent bacteria and resistance patterns in SC can aid the selection of empiric antibiotic therapy in high-risk patients.
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Hugosson J, Grenabo L, Hedelin H, Pettersson S, Seeberg S (1990) Bacteriology of upper urinary tract stones. J Urol 143(5):965–968
Michel Maurice Stephan, Trojan Lutz, Rassweiler Jens Jochen (2007) Complications in percutaneous nephrolithotomy. Eur Urol 51:899–906
Mariappan P, Smith G, Bariol SV et al (2005) Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following PCNL: a prospective clinical study. J Urol 173:1610–1614
Stamey TA (1980) Pathogenesis and treatment of urinary tract infections. Williams & Wilkins, Baltimore
Levy MM, Fink MP, Marshall JC et al (2001) Proceedings of the international sepsis definition conference. Crit Care Med 31:1250–1256
McAleer IM, Kaplan GW, Bradley JS et al (2002) Staghorn calculus endotoxin expression in sepsis. Urology 59:601–602
Fowler JE Jr (1984) Bacteriology of branched renal calculi and accompanying urinary tract infection. J Urol 131:213–215
McAleer I, KaplanGW Bradley JS et al (2003) Endotoxin content in the renal calculi. J Urol 169:1813–1814
Korets R, Graversen JA, Kates M, Mues AC, Gupta M (2011) Post percutaneous nephrolithotomy systemic inflammatory response. J Urol 186:1899–1903
Kumar S, Bag S, Ganesamoni R, Mandal AK, Taneja N, Singh SK (2012) Risk factors for urosepsis following percutaneous nephrolithotomy—role of 1 week of nitrofurantoin in reducing the risk of urosepsis. Urol Res 40:79–86
Aghdas FS, Akhavizadegan H, Aryanpoor A, Inanloo H, Karbakhsh M (2006) Fever after percutaneous nephrolithotomy: contributing factors. Surg Infect 7(4):367–371
Lojanapiwat B, Kitirattrakarn P (2011) Role of preoperative and intraoperative factors in mediating infection complication following percutaneous nephrolithotomy. Urol Int 86:448–452
Dogan HS, Guliyev F, Cetinkaya YS et al (2007) Importance of microbiological evaluation in management of infectious complications following percutaneous nephrolithotomy. Int Urol Nephrol 39:737
Stuart Wolf J Jr (2012) Percutaneous approaches to the upper urinary tract collecting system. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA (eds) Campbell-Walsh urology, 10th edn. Saunders Elsevier, Philadelphia, pp 1324–1356
Segura JW, Preminger GM, Assimos DG, Dretler SP, Kahn RI, Lingeman JE et al (1994) Nephrolithiasis clinical guidelines panel summary report on the management of staghorn calculi. J Urol 151:1648
O’Keeffe NK, Mortimer AJ, Sambrook PA et al (1993) Severe sepsis following percutaneous or endoscopic procedures for urinary tract stones. Br J Urol 72:277–283
Nemoy NJ, Stamey TA (1971) Surgical, bacteriological and biochemical management of infection stones. JAMA 215:1470–1476
Gonen M, Turan H, Ozturk B et al (2008) Factors affecting fever following percutaneous nephrolithotomy: a prospective clinical study. J Endourol 22:2135
Mariappan P, Loong CW (2004) Mid stream urine C&S test is a poor predictor of infected urine proximal to the obstructing ureteric stone or infected stones: a prospective clinical study. J Urol 171:2142–2145
Margel D, Ehrlich Y, Brown N, Lask D, Livne MP, Lifshitz D (2006) Clinical implication of routine stone culture in percutaneous nephrolithotomy—a prospective study. Urology 67:26
Naber KG, Bergman B, Bishop MC et al (2001) Urinary Tract Infection (UTI) Working Group of the Health Care Office (HCO) of the European Association of Urology (EAU). EAU guidelines for the management of urinary and male genital tract infections. Eur Urol 40(5):576–588
Mariappan P, Smith G, Moussa SA, Tolley DA (2006) One week of ciprofloxacin before percutaneous nephrolithotomy significantly reduces upper tract infection and urosepsis: a prospective controlled study. BJU Int 98:1075–1079
Mariappan P, Tolley DA (2005) Endoscopic stone surgery: minimizing the risk of post-operative sepsis. Curr Opin Urol 15:101–105
Carson C, Naber KG (2004) Role of fluoroquinolones in the treatment of serious bacterial urinary tract infections. Drugs 64:1359–1373
Dogan HS, Sahin A, Cetinkaya Y, Akdogan B, Ozden E, Kendi S (2002) Antibiotic prophylaxis in percutaneous nephrolithotomy: prospective study in 81 patients. J Endourol 16:649–653
Bouza E, San Juan R, Mun˜oz P, Voss A, J. Kluytmans on behalf of the Co-operative Group of the European Study Group on Nosocomial Infections (ESGNI) (2001) A European perspective on nosocomial urinary tract infections I. Report on the microbiology workload, etiology and antimicrobial susceptibility (ESGNI_003 study). Clin Microbiol Infect 7:523–531
Lifshitz DA, Winkler HZ, Gross M, Sulkes J, Baniel J, Livne PM (1993) Predictive value of urinary cultures in assessment of microbial colonization of ureteral stents. J Endourol 13(10):735–738
Cek M, Tandog˘du Z, Naber K, Tenke P, Wagenlehner F, van Oostrum E, Kristensen B, Truls Erik Bjerklund Johansen on behalf of the Global Prevalence Study of Infections in Urology Investigators (2013) Antibiotic prophylaxis in urology departments, 2005–2010. Eur Urol 63:386–394
Eswara Jairam R, Sharif-Tabrizi Ahmad, Sacco Dianne (2013) Positive stone culture is associated with a higher rate of sepsis after endourological procedures. Urolithiasis 41:411–414
Koras O, Bozkurt IH, Yonguc T, Degirmenci T, Arslan B, Gunlusoy B, Aydogdu O, Minareci S (2014) Risk factors for postoperative infectious complications following percutaneous nephrolithotomy: a prospective clinical study. Urolithiasis. doi:10.1007/s00240-014-0730-8
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Shoshany, O., Margel, D., Finz, C. et al. Percutaneous nephrolithotomy for infection stones: what is the risk for postoperative sepsis? A retrospective cohort study. Urolithiasis 43, 237–242 (2015). https://doi.org/10.1007/s00240-014-0747-z
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DOI: https://doi.org/10.1007/s00240-014-0747-z