Bacteriuria and Colonization of Double-Pigtail Ureteral Stents: Long-Term Experience with 237 Patients

Abstract

We prospectively studied 266 patients with indwelling double-pigtail ureteral stents to determine the incidence of stent colonization and associated bacteriuria. A urine culture was obtained just prior to stent insertion and was repeated at the time of its removal. The stent itself was also cultured. Of the 237 evaluable patients, 71 (29.9%) developed bacteriuria. Of the 237 stents, 161 (67.9%) became colonized with microorganisms. Pseudomonas aeruginosa was the most common pathogen isolated from the urine and the stents. Stents in female patients had a higher rate of colonization than those used in males (74.4% v 66.5%). The longer the duration of stenting, the higher was the rate of colonization (58.6% for stents left for < 1 month v 75.1% for those left for > 3 months). The rate of colonization according to catheter type was as follows: C-flex 55.5%, silicone 62.6%, urethane 100%, and Urosoft 56%. Long-term ureteric stenting is associated with a high rate of bacteriuria and stent colonization. The duration of stenting and the type of stent influence the results. We recommend that patients with double-J ureteral stents who could be at risk from bacteremia be covered by appropriate antibiotics, and the stents should be kept indwelling for the shortest possible time. If a patient with a stent develops symptomatic infection, an antibiotic should be started that covers the Pseudomonas species.

Improved detection of microbial ureteral stent colonisation by sonication

“…Since UTI and bacteriuria are more common in women than in men, this observation is comprehensible. Previous studies showed similar results [2][3][4]8]. The increase in MUSC in stents derived from patients older than 50 years might be associated with the age-related increase in bacteriuria.…”

“…The role of CUC in predicting MUSC was discussed previously [2][3][4][5][6][7][8]. However, an exact differentiation between pathogens and contaminating organisms is missing in all studies, resulting in a higher rate of positive CUC when compared to our results.…”

“…The issue of MUSC has not been well studied previously. Available data are inconsistent and controversial [2][3][4][5][6][7][8][9][10]. Microbiologic diagnosis of MUSC is difficult, since routine culture techniques do not accurately detect microorganisms embedded in biofilms.…”

Biofilm and Urogenital Infections

“…In vitro and in vivo studies confirmed the difficulty in detecting biofilm formation by using conventional laboratory procedures [38,39]. Reid at al found that 90% of indwelling silicone double J stents were colonized by adherent bacteria, however the incidence of urinary infection detected clinically was only 27% [38].…”

“…The difficulty in detecting biofilm formation by using conventional laboratory procedures was confirmed in a large study where 237 ureteral stents were tested. It was shown that 68% of stents were actually colonized but only 30% of patients were found to have bacteriuria [39]. Therefore, a negative urine culture does not rule out the possibility of stent colonization.…”