Abstract
Purpose
Patients with ureteric stents have symptoms that overlap with infection symptoms. Thus, clinicians unnecessarily give antibiotics to stented patients with bacteriuria despite guidelines. In stented patients, little is known about risk factors for developing bacteriuria or urosepsis. The objectives were to identify the frequency and risk factors for developing bacteriuria and urosepsis in patients with stents.
Methods
In this retrospective cohort study, we reviewed patients with ureteric stents placed or exchanged over 1 year. We examined associations between bacteriuria or urosepsis and host risk factors. Univariable and multivariable logistic analyses were performed.
Results
Of 286 patients (mean age: 57.2 years), 167 (58.4%) were male. The main stent indications were stone, stricture, cancer and extrinsic compression. The median stented period was 61 days. The frequency of bacteriuria was 59/286 (21%). ASA status 3 and 4 had 5 times the odds of having bacteriuria relative to ASA status 1. Stent duration > 2 months had 5.5 times the odds relative to ≤ 2 months. Urosepsis was infrequent, 13/286 (4.5%). Five patients had bacteraemia. A stent duration over 2 months had nearly 6 times the odds of urosepsis.
Conclusion
ASA status higher than 2 and stent time greater than 2 months raise the odds of developing bacteriuria. A stent duration longer than 2 months was the only predictor of urosepsis. Though 21% of patients had bacteriuria, 4.5% had urosepsis. Hence, bacteriuria without sepsis should not be treated with antibiotics, thus aiding antimicrobial stewardship.
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Data availability
The data supporting this study’s findings are not openly available due to patient confidentiality.
References
Shaw GL, Choong SK, Fry C (2005) Encrustation of biomaterials in the urinary tract. Urol Res 33(1):17–22. https://doi.org/10.1007/s00240-004-0423-9
Gorman SP (1991) Microbial adherence and biofilm production. In: Denyer SP, Hugo VM (eds) Mechanism and actions of chemical Biocides. Blackwell Scientific Publications, Oxford, pp 271–295
Bonkat G, Bartoletti R, Bruyère F, Cai T, Geerlings SE, Köves B, Kranz J, Schubert S, Pilatz A, Veeratterapillay R, Wagenlehner F et al (2023) EAU Guidelines on Urological Infections. In: EAU Guidelines, edition presented at the annual EAU Congress Milan 2023. ISBN 978-94-92671-19-6
SMI B 41: investigation of urine. UK Standards for Microbiology Investigations for urine. From: Public Health England. Published. 18 July 2014. Last updated. 11 January 2019. Available at https://www.gov.uk/government/publications/smi-b-41-investigation-of-urine. Accessed 13 Nov 2023
Chronic kidney disease. From: National Kidney Federation (UK). Available at https://www.kidney.org.uk/chronic-kidney-disease. Accessed 13 Nov 2023
Keane PF, Bonner MC, Johnston SR, Zafar A, Gorman SP (1994) Characterization of biofilm and encrustation on ureteric stents in vivo. Br J Urol 73(6):687–691
Franco G, De Dominicis C, Dal Forno S, Iori F, Laurenti C (1990) The incidence of post-operative urinary tract infection in patients with ureteric stents. Br J Urol 65(1):10–12
Reid G, Denstedt JD, Kang YS, Lam D, Nause C (1992) Microbial adhesion and biofilm formation on ureteral stents in vitro and in vivo. J Urol 148(5):1592–1594
Farsi HM, Mosli HA, Al-Zemaity MF, Bahnassy AA, Alvarez M (1995) Bacteriuria and colonization of double-pigtail ureteral stents: long-term experience with 237 patients. J Endourol 9(6):469–472
Riedl CR, Plas E, Hübner WA, Zimmerl H, Ulrich W, Pflüger H (1999) Bacterial colonization of ureteral stents. Eur Urol 36(1):53–59
Lifshitz DA, Winkler HZ, Gross M, Sulkes J, Baniel J, Livne PM (1999) Predictive value of urinary cultures in assessment of microbial colonization of ureteral stents. J Endourol 13(10):735–738
Klis R, Korczak-Kozakiewicz E, Denys A, Sosnowski M, Rozanski W (2009) Relationship between urinary tract infection and self-retaining Double-J catheter colonization. J Endourol 23(6):1015–1019
Geraghty RM, Pietropaolo A, Villa L, Fitzpatrick J, Shaw M, Veeratterapillay R, Rogers A, Ventimiglia E, Somani BK (2022) Post-ureteroscopy infections are linked to pre-operative stent dwell time over two months: outcomes of three european endourology centres. J Clin Med 11(2):310
Kehinde EO, Rotimi VO, Al-Hunayan A, Abdul-Halim H, Boland F, Al-Awadi KA (2004) Bacteriology of urinary tract infection associated with indwelling J ureteral stents. J Endourol 18(9):891–896
Paick SH, Park HK, Oh SJ, Kim HH (2003) Characteristics of bacterial colonization and urinary tract infection after indwelling of double-J ureteral stent. Urology 62(2):214–217. https://doi.org/10.1016/s0090-4295(03)00325-x
Kehinde EO, Rotimi VO, Al-Awadi KA, Abdul-Halim H, Boland F, Al-Hunayan A, Pazhoor A (2002) Factors predisposing to urinary tract infection after J ureteral stent insertion. J Urol 167(3):1334–1337
Al-Ghazo MA, Ghalayini IF, Matani YS, El-Radaideh KM, Haddad HI (2010) The risk of bacteriuria and ureteric stent colonization in immune-compromised patients with double J stent insertion. Int Urol Nephrol 42(2):343–347. https://doi.org/10.1007/s11255-009-9607-0
Scotland KB, Lange D (2018) Prevention and management of urosepsis triggered by ureteroscopy. Res Rep Urol 10:43–49
Liaw A, Knudsen B (2016) Urinary tract infections associated with ureteral stents: a review. Arch Esp Urol 69(8):479–484
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We thank Ms Linda Liu, London North West Healthcare NHS Trust Library, for her help with library resources.
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DB: project development, data oversight and manuscript writing. ME: data collection and data oversight. RC: data collection. PB: data analysis. GGR: project development and manuscript writing. All authors reviewed the draft and approved the submission.
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Ethical approval was granted by The London North West University Healthcare NHS Trust Institutional Review Board (approval number: R1K-DIVI-2023-0009). All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and in accordance with the Declaration of Helsinki and its later amendments or comparable ethical standards.
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Batura, D., Elsweefy, M., Chouhan, R. et al. Bacteriuria in patients with stented ureters: predictors of infection in patients presenting to the hospital and when not to treat. World J Urol 42, 196 (2024). https://doi.org/10.1007/s00345-024-04900-x
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DOI: https://doi.org/10.1007/s00345-024-04900-x