Epidemiology and risk factors for ureteral stent-associated urinary tract infections in non-transplanted renal patients: a systematic review of the literature

Vallée, M.; Bey, E.; Bouiller, Kévin; Goux, C.; Pimpie, Romain; Tourret-Arnaud, Jérome; Lina, Gérard; Figueiredo, Samy; Chauvin, Anthony; Gavazzi, G.; Malavaud, S.; Sotto, Albert; Bruyère, F.

doi:10.1007/s00345-021-03693-7

Cited by 7 publications

(8 citation statements)

References 34 publications

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“…Altunal et al reported similar results (35). In addition, previous systematic reviews have reported that Staphylococcus, E. coli, Klebsiella species, P. aeruginosa, Enterococcus, and Candida species were the microorganisms most commonly identified in urine or ureteral stents (16,17).…”

Section: Discussionmentioning

confidence: 78%

“…Therefore, severely impaired renal function (in particular CKD state 4 and 5) may result in both concentrated bacteria and subsequent development of symptomatic UTI which is consistent with our results. In previous literature reviews (16,17), CKD appeared to be associated with an increased colonization rate of ureteral stents without any clear evidence of an increase in the development of UTI, although the methodological quality of the included studies was inadequate to derive any clear conclusions. It is known that fewer virulence factors are required for infection in patients with ureteral stents than in those with good function of the urinary tract.…”

Section: Discussionmentioning

confidence: 98%

“…coli , Klebsiella species, P . aeruginosa , Enterococcus , and Candida species were the microorganisms most commonly identified in urine or ureteral stents ( 16 , 17 ).…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, only a few studies have assessed the pathophysiology and risk factors for the development of symptomatic UTI in these patients. Recently, two literature reviews have attempted to clarify the epidemiological characteristics and risk factors for UTI in patients with ureteral stents; however, they could not come to clear conclusions due to discrepancies in methodology and a low level of evidence of the included studies ( 16 , 17 ).…”

Section: Introductionmentioning

confidence: 99%

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Determination of microbiological characteristics and risk factors associated with bacteriuria and symptomatic urinary tract infection in patients with retained ureteral stents: an observational study

Kim¹,

Yeo²,

Park³

et al. 2023

Transl Androl Urol

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Background: The maintenance of ureteral stents is vital in patients with severe ureteral stricture or ureteral obstruction. This study aimed to identify microbiological characteristics and factors associated with bacteriuria and symptomatic urinary tract infection (UTI) in these patients.Methods: This study is an observational cross-sectional study. From August 2018 to January 2021, urine samples from 307 consecutive patients who required stent indwelling and had replaced ureteral stents more than once were collected before the replacement procedure and analyzed by microbiological testing. Patient demographics, laboratory test results, and data on dependent functional capacity and indwelling urethral catheter use were collected from all patients. Additionally, ureteral stenting duration and number of previous ureteral stent replacements were reviewed. The primary endpoint was the incidence rate of bacteriuria and extended-spectrum beta-lactamase (ESBL)-producing bacteria. The secondary endpoint was the factors predisposing patients with ureteral stents to bacteriuria, ESBL-producing bacteria, and the development of symptomatic UTIs.Results: Bacteriuria was observed in 187 patients (60.9%). Among the bacteria identified in urine, Escherichia coli was the most commonly isolated microorganism, followed by Enterococcus, Candida species, Staphylococcus species, Klebsiella, and Pseudomonas. Using multivariate analysis, bacteriuria was significantly associated with old age, female sex, presence of diabetes mellitus, impaired renal function, and longer duration of ureteral stenting. ESBL-producing bacteria were detected in 52 isolates (27.8%). The incidence of ESBL-producing bacteria in urine culture was associated with old age and longer ureteral stenting duration. Additionally, symptomatic UTIs developed in 22 patients (7.2%). Dependent functional capacity, impaired renal function, and longer ureteral stenting duration were significantly associated with symptomatic UTIs.Conclusions: Infections related to ureteral stents showed a specific microorganism profile and resistance pattern compared to community-acquired UTIs. Additionally, we identified the factors associated with bacteriuria and symptomatic UTI in patients with retained ureteral stents and deduced that these may be associated with better outcomes in patients with retained ureteral stents.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 98%

“…coli , Klebsiella species, P . aeruginosa , Enterococcus , and Candida species were the microorganisms most commonly identified in urine or ureteral stents ( 16 , 17 ).…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Determination of microbiological characteristics and risk factors associated with bacteriuria and symptomatic urinary tract infection in patients with retained ureteral stents: an observational study

Kim¹,

Yeo²,

Park³

et al. 2023

Transl Androl Urol

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“…Although there were some differences between the reported studies, Staphylococcus spp., E. coli, Klebsiella spp., P. aeruginosa, Enterococcus spp., and Candida spp. were most often responsible for ureteral stent colonization [11]. Unfortunately, few studies have reported the treatment of confirmed asymptomatic bacteriuria when considering ureteral stent removal.…”

Section: Discussionmentioning

confidence: 99%

Predictor for Ureteral Stent Removal in Gynecological Cancer Patients with a Ureteral Obstruction

Hong

et al. 2022

Urogenit Tract Infect

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Purpose: This study investigated the possibility of ureteral stent removal in patients with gynecological cancer and ureteral obstruction. Materials and Methods: From February 2010 to March 2022, the records of 121 patients with gynecological cancer and ureteral obstruction undergoing periodic ureteral stent replacement were reviewed retrospectively. Ureteral stent removal was attempted in patients who showed improvement in hydronephrosis on abdominal computed tomography (CT) after ureteral stent insertion and who lost symptoms. Success was defined as not having to reinsert the stent because there were no uncomfortable symptoms. The following were evaluated as predictors for ureteral stent removal: pre-removal serum creatinine, hypertension, diabetes, asymptomatic bacteriuria, type of gynecologic malignancy, prior radiotherapy, hydronephrosis laterality, obstruction level, hydronephrosis etiology, ureteral stent size, and ureteral stent duration. The hydronephrosis changes on abdominal CT were also evaluated. Results: Among 121 patients, 74 with 81 obstructed ureters were evaluated. Of the 81 ureters, successful removal occurred in 30 (37.0%). There were significant differences between the success and failure cases regarding asymptomatic bacteriuria, prior radiotherapy, and hydronephrosis etiology. Logistic regression analysis showed that asymptomatic bacteriuria and hydronephrosis etiology were significant predictors of ureteral stent removal (p<0.05). There were also significant differences in the hydronephrosis changes depending on asymptomatic bacteriuria and hydronephrosis etiology (p<0.05). Conclusions: In patients with gynecological cancer who have a ureteral stent in place due to ureteral obstruction, ureteral stent removal may be considered in patients who do not have asymptomatic bacteriuria or other etiologies, such as external ureteral pressure or ureteral cancer metastasis.

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Asymptomatic bacteriuria prior to partial and radical nephrectomy: To screen or not to screen? Results from the national and multicenter TOCUS database

Ayoub,

Kutchukian,

Bigot

et al. 2024

World J Urol

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Epidemiology and risk factors for ureteral stent-associated urinary tract infections in non-transplanted renal patients: a systematic review of the literature

Cited by 7 publications

References 34 publications

Determination of microbiological characteristics and risk factors associated with bacteriuria and symptomatic urinary tract infection in patients with retained ureteral stents: an observational study

Determination of microbiological characteristics and risk factors associated with bacteriuria and symptomatic urinary tract infection in patients with retained ureteral stents: an observational study

Predictor for Ureteral Stent Removal in Gynecological Cancer Patients with a Ureteral Obstruction

Asymptomatic bacteriuria prior to partial and radical nephrectomy: To screen or not to screen? Results from the national and multicenter TOCUS database

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