Advertisement

A systematic review of the clinical significance of nephrostomy urine cultures

  • Deepak BaturaEmail author
  • G. Gopal Rao
Topic Paper

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 Drainage 

Notes

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.

References

  1. 1.
    Kandil H, Cramp E, Vaghela T (2016) Trends in antibiotic resistance in urologic practice. Eur Urol Focus 2(4):363–373.  https://doi.org/10.1016/j.euf.2016.09.006 CrossRefGoogle Scholar
  2. 2.
    Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700.  https://doi.org/10.1136/BMJ.B2700 CrossRefGoogle Scholar
  3. 3.
    Koh D, Lau KK, Teoh E (2018) Are all urgent nephrostomies that urgent? Emerg Radiol 25:381–386.  https://doi.org/10.1007/s10140-018-1598-7 CrossRefGoogle Scholar
  4. 4.
    Benson AD, Juliano TM, Miller NL (2014) Infectious outcomes of nephrostomy drainage before percutaneous nephrolithotomy compared to concurrent access. J Urol 192:770–774.  https://doi.org/10.1016/j.juro.2014.03.004 CrossRefGoogle Scholar
  5. 5.
    Sancaktutar AA, Bozkurt Y, Tüfek A et al (2013) Radiation-free percutaneous nephrostomy performed on neonates, infants, and preschool-age children. J Pediatr Urol 9:464–471.  https://doi.org/10.1016/j.jpurol.2012.06.001 CrossRefGoogle Scholar
  6. 6.
    Bahu R, Chaftari A-M, Hachem RY et al (2013) Nephrostomy tube related pyelonephritis in patients with cancer: epidemiology, infection rate and risk factors. J Urol 189:130–135.  https://doi.org/10.1016/j.juro.2012.08.094 CrossRefGoogle Scholar
  7. 7.
    Etemadian M, Haghighi R, Madineay A, Tizeno A (2008) Delayed versus same-day percutaneous nephrolithotomy in patients with aspirated cloudy urine. Urol J 5:28–33Google Scholar
  8. 8.
    Watson RA, Esposito M, Richter F et al (1999) Percutaneous nephrostomy as adjunct management in advanced upper urinary tract infection. Urology 54:234–239.  https://doi.org/10.1016/S0090-4295(99)00091-6 CrossRefGoogle Scholar
  9. 9.
    Pearle MS, Pierce HL, Miller GL et al (1998) Optimal method of urgent decompression of the collecting system for obstruction and infection due to ureteral calculi. J Urol 160:1260–1264CrossRefGoogle Scholar
  10. 10.
    Cox M, Dong H, Momah I, Selvarajan S (2015) Preprocedural urinalysis in percutaneous nephrostomy for pyonephrosis: does a normal urinalysis rule out pyonephrosis? Experience at an urban tertiary care center. J Vasc Interv Radiol 26:S45.  https://doi.org/10.1016/j.jvir.2014.12.128 CrossRefGoogle Scholar
  11. 11.
    Ng SKK, Pun TCT, Kan CF, Chan SWH AW (2014) Is percutaneous nephrostomy (PCN) urine culture necessary before PCN revision? BJU 113:S1.  https://doi.org/10.1111/bju.12606 Google Scholar
  12. 12.
    Dede G, Deveci Ö, Dede O et al (2016) For reliable urine cultures in the detection of complicated urinary tract infection, do we use urine specimens obtained with urethral catheter or a nephrostomy tube? Turkish J Urol 42:290–294.  https://doi.org/10.5152/tud.2016.00947 CrossRefGoogle Scholar
  13. 13.
    Bahu R, Chaftari A, Hachem RY et al (2013) Infection/inflammation nephrostomy tube related pyelonephritis in patients with cancer: epidemiology, infection rate and risk factors. JURO 189:130–135.  https://doi.org/10.1016/j.juro.2012.08.094 Google Scholar
  14. 14.
    Horsu H (2014) Post-nephrostomy sepsis and septic shock rate, predictive risk factors and ways of improving patient outcomes—an audit. Eur Urol Suppl 13(5):174–175CrossRefGoogle Scholar
  15. 15.
    Maneevese M, Sabir S, Ahrar K (2018) Risk factors associated with development of percutaneous nephrostomy related urinary tract infection (PN-CAUTI). J Vasc Interv Radiol 29(4):S290.  https://doi.org/10.1016/j.jvir.2018.01.750 CrossRefGoogle Scholar
  16. 16.
    Huang EYH, Chung HJ, Lin CC et al (2014) Is preoperative UTI associated with increased risks of UTI after ureteroscopic lithotripsy? A nationwide population-based study. Eur Urol Suppl 13(1):e1033.  https://doi.org/10.1016/S1569-9056(14)61016-2 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of UrologyLondon North West University Healthcare NHS TrustLondonUK
  2. 2.Department of MicrobiologyLondon North West University Healthcare NHS TrustLondonUK

Personalised recommendations