A systematic review of the clinical significance of nephrostomy urine cultures
Abstract
Purpose
There are few published reviews that have assessed the clinical utility of renal urine cultures following percutaneous nephrostomy (PCN). In this systematic review, we evaluated the published evidence of the clinical utility of nephrostomy urine cultures in the light of emerging antimicrobial resistance and need for stewardship.
Methods
We performed a systematic literature search and review for evidence on the utility and role of nephrostomy urine cultures, using Medline, Embase and PubMed. We looked for evidence to assess whether there is any utility in collecting renal urine for culture at the time of percutaneous nephrostomy (PCN) and if the culture results of nephrostomy urine and bladder urine are different. We studied outcomes of treatment based on nephrostomy culture results. We also examined the role of PCN cultures at the time of routine nephrostomy exchange. Finally, we assessed if doing a PCN leads to infection or pyelonephritis.
Results
From 94 studies initially identified, we finally selected two randomised clinical trials (RCT), six original articles and five detailed conference abstracts for the review. These studies suggest that PCN urine cultures are overall useful in clinical practice. They are useful in selecting appropriate antimicrobial treatment for urosepsis following upper urinary obstruction. There does not appear to be any advantage in performing PCN cultures at routine nephrostomy exchanges. Occasionally, PCN itself can lead to subsequent urosepsis.
Conclusion
Nephrostomy urine cultures have utility in clinical practice and can help support treatment and antimicrobial stewardship.
Keywords
Percutaneous nephrostomy Urinalysis Bacteriuria Urinary tract infections Risk factors DrainageNotes
Acknowledgements
We gratefully acknowledge Ms Irena Scicinska, Librarian, for her help with our search methods.
Author contributions
DB: project development, data collection, and manuscript writing. GGR: project development, and manuscript writing.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
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