Clinical Implications of Stent Culture in Patients with Indwelling Ureteral Stents Prior to Ureteroscopy

Nevo, Amihay; Schreter, Eran; Lifshitz, David A.

doi:10.1016/j.juro.2017.01.064

Cited by 21 publications

(21 citation statements)

References 24 publications

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“…Usually, globulin plays an important role in immunity and inflammation. In the early phase of infection, the immunoglobulin level elevated rapidly (Nevo et al, 2017), which may account for the results in our study. A low AGR may indicate a susceptible state to infection.…”

Section: Discussionsupporting

confidence: 75%

A preoperative nomogram for sepsis in percutaneous nephrolithotomy treating solitary, unilateral and proximal ureteral stones

Yang¹,

Yang²,

Yu³

et al. 2020

PeerJ

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Background Postoperative sepsis is a lethal complication for percutaneous nephrolithotomy (PCNL). An early predictive model combined local and systemic conditions is urgently needed to predict infectious events. We aim to determine the preoperative predictors of sepsis after PCNL in patients with unilateral, solitary, and proximal ureteral stones. Methods A total of 745 patients who underwent PCNL between January 2012 and December 2018 were retrospectively enrolled. Sepsis was defined based on the International Sepsis Definitions in 2001, and the preoperative factors were compared between the non-sepsis and sepsis groups. Univariable analysis and multivariable logistic regression analysis were conducted to determine the predictors for sepsis after PCNL. A nomogram was generated using the predictors. Results In this study, 35 patients (4.7%) developed sepsis after PCNL. Univariate analysis showed that post-PCNL sepsis was associated with the female, lower albumin, higher globulin, lower albumin globulin ratio (AGR < 1.5), preoperative fever, leukocytosis (WBC ≥ 10,000 cells/μL), positive urine culture, leukocyturia (≥50 cells/μL) and positive urine nitrite. Multivariate logistic regression analysis suggested that AGR < 1.5 (odds ratio [OR] = 5.068, 95% confidence interval [CI] [1.135–22.624], P = 0.033), positive urine culture (OR = 3.243, 95% CI [1.162–9.047], P = 0.025), leukocytosis (OR = 3.706, 95% CI [1.444–9.512], P = 0.006) and female (OR = 2.529, 95% CI [1.127–5.672], P = 0.024) were independent risk factors for sepsis. A nomogram was generated and displayed favorable fitting (Hosmer–Lemeshow test P = 0.797), discrimination (area under receiver operating characteristic curve was 0.807), and clinical usefulness by decision curve analysis. Conclusions Patients with certain preoperative characteristics, such as female, lower AGR, positive urine culture, and leukocytosis, who undergo PCNL may have a higher risk of developing sepsis. A cautious preoperative evaluation and optimized treatment strategy should be considered in these patients to minimize infectious complications.

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Section: Discussionsupporting

confidence: 75%

A preoperative nomogram for sepsis in percutaneous nephrolithotomy treating solitary, unilateral and proximal ureteral stones

Yang¹,

Yang²,

Yu³

et al. 2020

PeerJ

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“…Usually, globulin plays an important role in immunity and inflammation. In the early phase of infection, the immunoglobulin level elevated rapidly 19 , which may account for the results in our study. A low AGR may indicate a susceptible state to infection.…”

Section: Discussionsupporting

confidence: 75%

Peer Review #1 of "A preoperative nomogram for sepsis in percutaneous nephrolithotomy treating solitary, unilateral and proximal ureteral stones (v0.1)"

Rashid¹

2020

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BACKGROUND: Postoperative sepsis is a lethal complication for percutaneous nephrolithotomy (PCNL). An early predictive model combined local and systemic conditions is urgently needed to predict infectious events. We aim to determine the preoperative predictors of sepsis after PCNL in patients with unilateral, solitary, and proximal ureteral stones. METHODS: A total of 745 patients who underwent PCNL between January 2012 and December 2018 were retrospectively enrolled. Sepsis was defined based on the International Sepsis Definitions in 2001, and the preoperative factors were compared between the non-sepsis and sepsis groups. Univariable analysis and multivariable logistic regression analysis were conducted to determine the predictors for sepsis after PCNL. A nomogram was generated using the predictors. RESULTS: In this study, 35 patients (4.7%) developed sepsis after PCNL. Univariate analysis showed that post-PCNL sepsis was associated with the female, lower albumin, higher globulin, lower albumin globulin ratio (AGR <1.5), preoperative fever, leukocytosis (WBC ≥10,000 cells/μL), positive urine culture, leukocyturia (≥50 cells/μL) and positive urine nitrite. Multivariate logistic regression analysis suggested that AGR <1.5 (odds ratio [OR]=5.068, 95% confidence interval [CI]=1.135-22.624, P = 0.033), positive urine culture (OR=3.243, 95% CI=1.162-9.047, P =0.025), leukocytosis (OR=3.706, 95% CI=1.444-9.512, P =0.006), and female (OR=2.529, 95% CI=1.127-5.672, P =0.024) were independent risk factors for sepsis. A nomogram was generated and displayed favorable fitting (Hosmer-Lemeshow test P =0.797), discrimination (area under receiver operating characteristic curve was 0.807), and clinical usefulness by decision curve analysis. CONCLUSIONS: Patients with certain preoperative characteristics, such as female, lower AGR, positive urine culture, and leukocytosis, who undergo PCNL may have a higher risk of developing sepsis. A cautious preoperative evaluation and optimized treatment strategy should be considered in these patients to minimize infectious complications.

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“…Therefore, endoscopic procedures after stent removal increase the risk of infectious complications, even if preoperative UC is negative. Nevo et al (22) found SC positivity in 20.4% of their pre-stented patients prior to ureteroscopic surgery and concluded that positive SC was associated with a higher risk of post-URS sepsis in females and patient with comorbidity. They reported that positive SC was an independent predictor of post-URS sepsis.…”

Section: Discussionmentioning

confidence: 99%

“…Kehinde et al (12) showed that these comorbities were associated with significantly higher rates of bacteriuria and stent colonization. In several studies, sex and age were reported to be significant predisposing factors for stent colonization (12,22). On the contrary, Lifshitz et al (8) stated that age and sex had no influence on the incidence of bacteriuria and stent colonization.…”

Section: Discussionmentioning

confidence: 99%

Bacterial Colonization of Ureteral Double-J Stents in Patients with Negative Urine Culture

Ülker¹,

Yılmaz²,

Ağuş³

et al. 2019

jus

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Amaç: Üreteral çift-J stentler üroloji uygulamalarında yoğun olarak kullanılmaktadır. Prospektif bir çalışma ile idrar kültürü negatif olan hastalarda üreteral çift-J stentlerdeki bakteriyel kolonizasyon ve baskın mikroorganizmaların araştırılması amaçlanmıştır. Gereç ve Yöntem: Otuz beş ardışık hastadan çıkartılan 35 çift-J stent incelendi. Sistoskopik olarak çıkartılan stentler üst, orta ve alt olarak üç parçaya ayrılarak stent çıkartılmadan hemen önce alınan idrar örneği ile birlikte mikrobiyolojik incelemeye gönderildi. Örnekler kanlı-agar ve eozinmetilen mavisi agar besiyerlerine ekildi. Üremede >1000 koloni ünite/mL anlamlı olarak kabul edildi. Antibiyotik hassasiyet testi 10 geniş spektrumlu antibiyotik ile yapıldı. Bulgular: Çıkartılan 35 stentin %20'sinde bakteriyel kolonizasyon saptandı. En sık üreyen bakteri Staphilococcuss epidermidis, ardından Escherischia coli ve Enterococcus faecalis idi. %71,4 olguda stentin tüm kısımlarında kolonizasyon saptandı. Stent kalış süresi ve stent kültürü pozitifliği arasında uyum vardı (p=0,035). Ancak cinsiyet ve yaş ile stent kolonizasyonu arasında bir ilişki saptanmadı (p≥0,05). Sonuç: Üreteral DJ stent bulunan hastalarda idrar kültürü negatif olsa bile stent kültürü pozitif olabilmektedir. Rutin olarak önerilmemekle birlikte stent kültürü endoürolojik cerrahi yapılacak yüksek riskli hastalarda gelişebilecek postoperatif üriner sistem enfeksiyonu ve sepsisin tedavisinde faydalı olabilir.

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Clinical Implications of Stent Culture in Patients with Indwelling Ureteral Stents Prior to Ureteroscopy

Cited by 21 publications

References 24 publications

A preoperative nomogram for sepsis in percutaneous nephrolithotomy treating solitary, unilateral and proximal ureteral stones

A preoperative nomogram for sepsis in percutaneous nephrolithotomy treating solitary, unilateral and proximal ureteral stones

Peer Review #1 of "A preoperative nomogram for sepsis in percutaneous nephrolithotomy treating solitary, unilateral and proximal ureteral stones (v0.1)"

Bacterial Colonization of Ureteral Double-J Stents in Patients with Negative Urine Culture

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