Positive stone culture is associated with a higher rate of sepsis after endourological procedures

Abstract

The purpose of this study was to determine if there is a correlation between urine and/or stone cultures with postoperative sepsis in patients treated for renal and ureteral calculi. Three hundred and twenty-eight consecutive patients who underwent percutaneous nephrolithotomy (PCNL) or ureteroscopy from 2006 to 2009 were identified, all of whom had a stone culture obtained during surgery. All had a preoperative urine culture. Two hundred and seventy-four underwent ureteroscopy and 54 PCNL. All patients had either negative preoperative urine cultures or were given preoperative antibiotics for 1-7 days prior to surgery. Stone fragments were obtained during the procedure and sent for analysis. The primary endpoint was sepsis. Of 328 patients, 3 % (11/328) developed postoperative sepsis. 73 % (8/11) had positive stone cultures, while none had a positive preoperative urine culture. 8 % (8/96) with positive stone cultures and 1 % (3/232) with negative stone cultures developed sepsis (p = 0.003). The stone culture grew the same pathogen as the urine culture obtained on readmission in 64 % (7/11) of the patients, while 9 % (1/11) of preoperative urine cultures correlated with the readmission pathogen (p = 0.02). The pathogen causing infection had a significantly higher correlation with the organism grown on stone culture than the preoperative urine culture. The patients who developed sepsis did so despite preoperative antibiotics, and the pathogen grown on the preoperative urine culture was different from that seen post operatively. These results suggest that stone culture is more informative than preoperative urine culture for determining treatment of postoperative sepsis.

The optimal minimally invasive percutaneous nephrolithotomy strategy for the treatment of staghorn stones in a solitary kidney

“…Infection complication is also a common and troublesome issue with PCNL. Many factors such as diabetes, positive preoperative urine culture, infection stones, staghorn stones, multiple punctures, and length of operative time had all been proven to be predictors for postoperative infection complications [13,14]. The present study showed that there was no significant difference in the rate of infection complication, including SIRS and septic shock, between both approaches.…”

Risk for Clostridium difficile infection after radical cystectomy for bladder cancer: Analysis of a contemporary series

“…Though the 2005 guideline from Infectious Diseases Society of America recommends routine treatment of asymptomatic bacteriuria in patients undergoing urological procedures 24 , recent data from patients undergoing stone surgery have questioned the value of preoperative urine culture, as asymptomatic bacteriuria is a poor predictor of postoperative infection. 25 Furthermore, several studies have shown that treatment of asymptomatic bacteriuria in bladder cancer patients undergoing outpatient urological procedures (ie. cystoscopy and intravesical therapy) is unnecessary as these patients did not have an increased risk of UTI.…”

The Risk Factors of Recurrent Febrile Urinary Tract Infection within 1 Year in Urinary Stone Patients with Acute Obstructive Pyelonephritis

“…However, the other 2 patients tested positive for PCN urine culture while negative for bladder urine culture. Eswara et al [12] reported that-among readmitted patients who developed sepsis after having undergone treatment for a stone-there was only 64% correspondence between whether both their stone culture and their urine culture tested positive. Additionally, another previous study reported that stone culture results were better correlated with pelvic, rather than bladder, urine culture results [13].…”