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The clinical role of bacteremia and bacterial spread into the irrigation fluid during percutaneous nephrolithotomy: a prospective study

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Abstract

Purpose

Backflow of pathogens and endotoxins from the renal pelvis to the bloodstream is one supposed mechanism for infectious complications development after endourological stones surgery. The aim of this study is detecting to prove bacterial spread into irrigation fluid and bloodstream during percutaneous nephrolithotomy (PCNL) and to correlate these findings with clinical and microbiological parameters and infectious complications (IC).

Methods

Bladder urine culture (BUC) was retrieved before PCNL; during the procedure, 2 blood samples (BC) and an irrigation fluid sample during fragmentation (SFUC) were collected for culture. Stone culture (SC) was also obtained. Patients were evaluated post-operatively for IC.

Results

Sixty-one patients were prospectively included. IC occurred in 15 patients (24.6%). SFUC was positive in 7/61 (11.5%); BC in 10/61 (16.4%). Among patients with positive BC; BUC, SFUC and SC were positive in 9 (90%), 6 (60%), and 8 (80%) cases, respectively. Out of 10 patients with positive BC, 4 developed post-operative IC. Pre-operative renal impairment (p = 0.04), intraoperative-evaluated stone residual (p = 0.02), BUC (p = 0.004), and SC (p = 0.008) were associated with IC. No correlation was found between bacterial spread in the irrigation fluid and blood and IC.

Conclusion

We proved that bacteria can be detected into the irrigation fluid and blood during PCNL. This transient bacteremia appears to be unrelated to IC development.

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Data availabilty

The datasets generated during and analysed during the current study are not publicly available due to privacy but are available from the corresponding author on reasonable request.

References

  1. EAU Guidelines. Edn. presented at the EAU Annual Congress Amsterdam, 2022. ISBN 978-94-92671-16-5

  2. Yu J, Guo B, Yu J, Chen T, Han X, Niu Q et al (2019) Antibiotic prophylaxis in perioperative period of percutaneous nephrolithotomy: a systematic review and meta-analysis of comparative studies. World J Urol. https://doi.org/10.1007/s00345-019-02967-5

    Article  Google Scholar 

  3. Wu C, Hua L-X, Zhang J-Z, Zhou X-R, Zhong W, Ni H-D (2017) Comparison of renal pelvic pressure and postoperative fever incidence between standard- and mini-tract percutaneous nephrolithotomy. Kaohsiung J Med Sci 33:36–43. https://doi.org/10.1016/j.kjms.2016.10.012

    Article  Google Scholar 

  4. Seitz C, Desai M, Häcker A, Hakenberg OW, Liatsikos E, Nagele U et al (2012) Incidence, prevention, and management of complications following percutaneous nephrolitholapaxy. Eur Urol 61:146–158. https://doi.org/10.1016/j.eururo.2011.09.016

    Article  Google Scholar 

  5. Fowler JE (1984) Bacteriology of branched renal calculi and accompanying urinary tract infection. J Urol 131:213–215. https://doi.org/10.1016/s0022-5347(17)50311-0

    Article  Google Scholar 

  6. Tokas T, Herrmann TRW, Skolarikos A, Nagele U (2019) Pressure matters: intrarenal pressures during normal and pathological conditions, and impact of increased values to renal physiology. World J Urol 37:125–131. https://doi.org/10.1007/s00345-018-2378-4

    Article  Google Scholar 

  7. McALEER IM, Kaplan GW, Bradley JS, Carroll SF, Griffith DP (2003) Endotoxin content in renal calculi. J Urol 169:1813–1814. https://doi.org/10.1097/01.ju.0000061965.51478.79

    Article  CAS  Google Scholar 

  8. Zanetti SP, Lievore E, Fontana M, Turetti M, Gallioli A, Longo F et al (2021) Vacuum-assisted mini-percutaneous nephrolithotomy: a new perspective in fragments clearance and intrarenal pressure control. World J Urol 39:1717–1723. https://doi.org/10.1007/s00345-020-03318-5

    Article  Google Scholar 

  9. Michel MS, Trojan L, Rassweiler JJ (2007) Complications in percutaneous nephrolithotomy. Eur Urol 51:899–906. https://doi.org/10.1016/j.eururo.2006.10.020

    Article  Google Scholar 

  10. Walton-Diaz A, Vinay JI, Barahona J, Daels P, González M, Hidalgo JP et al (2017) Concordance of renal stone culture: PMUC, RPUC, RSC and post-PCNL sepsis—a non-randomized prospective observation cohort study. Int Urol Nephrol 49:31–35. https://doi.org/10.1007/s11255-016-1457-y

    Article  CAS  Google Scholar 

  11. Dogan HS, Guliyev F, Cetinkaya YS, Sofikerim M, Ozden E, Sahin A (2007) Importance of microbiological evaluation in management of infectious complications following percutaneous nephrolithotomy. Int Urol Nephrol 39:737–742. https://doi.org/10.1007/s11255-006-9147-9

    Article  Google Scholar 

  12. Mariappan P, Loong CW (2004) Midstream urine culture and sensitivity test is a poor predictor of infected urine proximal to the obstructing ureteral stone or infected stones: a prospective clinical study. J Urol 171:2142–2145. https://doi.org/10.1097/01.ju.0000125116.62631.d2

    Article  Google Scholar 

  13. De Lorenzis E, Boeri L, Gallioli A, Fontana M, Zanetti SP, Longo F et al (2020) Feasibility and relevance of urine culture during stone fragmentation in patients undergoing percutaneous nephrolithotomy and retrograde intrarenal surgery: a prospective study. World J Urol. https://doi.org/10.1007/s00345-020-03387-6

    Article  Google Scholar 

  14. Cai T (2019) Infectious complications after laser vaporization of urinary stones during retrograde intrarenal surgery are not associated with spreading of bacteria into irrigation fluid but with previous use of fluoroquinolones 8

  15. de la Rosette JJMCH, Opondo D, Daels FPJ, Giusti G, Serrano Á, Kandasami SV et al (2012) Categorisation of complications and validation of the Clavien score for percutaneous nephrolithotomy. Eur Urol 62:246–255. https://doi.org/10.1016/j.eururo.2012.03.055

    Article  Google Scholar 

  16. EUCAST: EUCAST n.d. https://www.eucast.org/. Accessed 30 Mar 2022

  17. de la Rosette J, Assimos D, Desai M, Gutierrez J, Lingeman J, Scarpa R et al (2011) The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients. J Endourol 25:11–17. https://doi.org/10.1089/end.2010.0424

    Article  Google Scholar 

  18. Patel N, Shi W, Liss M, Raheem O, Wenzler D, Schallhorn C et al (2015) Multidrug resistant bacteriuria before percutaneous nephrolithotomy predicts for postoperative infectious complications. J Endourol 29:531–536. https://doi.org/10.1089/end.2014.0776

    Article  Google Scholar 

  19. Bansal SS, Pawar PW, Sawant AS, Tamhankar AS, Patil SR, Kasat GV (2017) Predictive factors for fever and sepsis following percutaneous nephrolithotomy: a review of 580 patients. Urol Ann 9:230–233. https://doi.org/10.4103/UA.UA_166_16

    Article  Google Scholar 

  20. Liu YQ, Lu J, Hao YC, Xiao CL, Ma LL (2018) Predicting model based on risk factors for urosepsis after percutaneous nephrolithotomy. Beijing Da Xue Xue Bao 50:507–513

    CAS  Google Scholar 

  21. Korets R, Graversen JA, Kates M, Mues AC, Gupta M (2011) Post-percutaneous nephrolithotomy systemic inflammatory response: a prospective analysis of preoperative urine, renal pelvic urine and stone cultures. J Urol 186:1899–1903. https://doi.org/10.1016/j.juro.2011.06.064

    Article  Google Scholar 

  22. Lightner DJ, Wymer K, Sanchez J, Kavoussi L (2020) Best practice statement on urologic procedures and antimicrobial prophylaxis. J Urol 203:351–356. https://doi.org/10.1097/JU.0000000000000509

    Article  Google Scholar 

  23. Liu J, Zhou C, Gao W, Huang H, Jiang X, Zhang D (2019) Does preoperative urine culture still play a role in predicting post-PCNL SIRS? A retrospective cohort study. Urolithiasis. https://doi.org/10.1007/s00240-019-01148-8

    Article  Google Scholar 

  24. Zeng T, Chen D, Wu W, Huang Y, Zhang S, Zhao Z et al (2020) Optimal perioperative antibiotic strategy for kidney stone patients treated with percutaneous nephrolithotomy. Int J Infect Dis 97:162–166. https://doi.org/10.1016/j.ijid.2020.05.095

    Article  Google Scholar 

  25. Sur RL, Krambeck AE, Large T, Bechis SK, Friedlander DF, Monga M et al (2021) A randomized controlled trial of preoperative prophylactic antibiotics for percutaneous nephrolithotomy in moderate to high infectious risk population: a report from the EDGE Consortium [Miscellaneous Article]. J Urol 205:1379–1385. https://doi.org/10.1097/JU.0000000000001582

    Article  Google Scholar 

  26. Xu P, Zhang S, Zhang Y, Zeng T, Chen D, Wu W et al (2022) Preoperative antibiotic therapy exceeding 7 days can minimize infectious complications after percutaneous nephrolithotomy in patients with positive urine culture. World J Urol 40:193–199. https://doi.org/10.1007/s00345-021-03834-y

    Article  Google Scholar 

  27. 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. https://doi.org/10.1111/j.1464-410X.2006.06450.x

    Article  Google Scholar 

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Acknowledgements

F. Del Signore for English revision.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Urology, IRCCS Foundation Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy

    Carlo Silvani, Stefano Paolo Zanetti, Luca Boeri, Matteo Turetti, Carolina Bebi, Matteo Malfatto, Giancarlo Albo, Michela Piccoli, Fabrizio Longo, Emanuele Montanari & Elisa De Lorenzis

  2. University of Milan, Milan, Italy

    Carlo Silvani, Matteo Turetti, Carolina Bebi, Matteo Malfatto, Giancarlo Albo & Emanuele Montanari

  3. Microbiology and Virology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Caterina Matinato & Antonio Teri

Authors
  1. Carlo Silvani
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  2. Stefano Paolo Zanetti
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  3. Luca Boeri
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  13. Elisa De Lorenzis
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Contributions

CS: data collection; data analysis; manuscript writing and editing. SPZ: data analysis, manuscript writing and editing. LB: manuscript writing and editing. MT: data collection. CM: project development; microbiological analysis and interpretation. Antonio Teri: project development; microbiological analysis and interpretation. CB: data collection. MM: data collection. GA: manuscript writing and editing. MP: data collection. FL: manuscript writing and editing. EM: project development; supervision. EDL: conceptualization; project development; data analysis; manuscript writing and editing.

Corresponding author

Correspondence to Carlo Silvani.

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The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of University of Milan (no. 45/18).

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Informed consent was obtained from all subjects involved in the study.

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Silvani, C., Zanetti, S.P., Boeri, L. et al. The clinical role of bacteremia and bacterial spread into the irrigation fluid during percutaneous nephrolithotomy: a prospective study. World J Urol 41, 135–142 (2023). https://doi.org/10.1007/s00345-022-04217-7

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  • DOI: https://doi.org/10.1007/s00345-022-04217-7

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