Stone culture retrieved during percutaneous nephrolithotomy: is it clinically relevant?

Abstract

Stone culture has been frequently investigated following percutaneous nephrolithotomy (PNL) in the last decade. We aimed to crucially define the clinical role of stone culture in modifying the treatment plan in patients with postoperative sepsis. Between June 2012 and April 2013, a total of 79 consecutive PNL procedures were included. Perioperative data were prospectively maintained. Preoperative urine sample, retrieved stone fragments and postoperative nephrostomy tube urine sample were cultured and antibiotic sensitivity tests were performed. The occurrence of at least two of the systemic inflammatory response syndrome (SIRS) events during their inpatient stay was diagnostic of SIRS. The antibiotic regimen utilized and its modifications were reported. The preoperative culture was positive in 26 patients (32.9 %). The culture of stone fragments showed significant bacterial growth in 23 (29.1 %) cases. Significant growth on stone culture was significantly associated with the presence of preoperative urinary catheters and positive preoperative urine culture (P = 0.001, 0.006 respectively). Postoperative culture was positive in only six patients (7.6 %). SIRS was diagnosed in the first postoperative day in 12 patients (15.2 %). Leukocytosis was the only predictor of SIRS. Neither preoperative culture, stone culture nor postoperative culture was predictor of SIRS. Stone culture was positive in four patients with SIRS. Stone culture changed the treatment plan in only one patient. Our data do not support the routine implementation of stone culture in the PNL workup, as it did not indicate a change of antibiotic regimen in most of the cases.

Feasibility and relevance of urine culture during stone fragmentation in patients undergoing percutaneous nephrolithotomy and retrograde intrarenal surgery: a prospective study

“…Our rate of antibiotic switching (20.7%) confirmed the clinical utility of SC. On the contrary, Osman et al reported that SC was clinically useful only in 1 patient with positive SC [25]. Despite a similar rate of SC positivity (28% in our series vs 29.1%), we included more patients (107 vs 79) and a greater number of stone variables.…”

A nomogram for predicting postoperative urosepsis following retrograde intrarenal surgery in upper urinary calculi patients with negative preoperative urine culture

“…Previous studies reported that an incidence of septic shock (1.09%) was noted in patients with negative preoperative UC 13 , which indicated that patients with negative UC were still at risk of serious infection complications after surgery. It has been reported that calculi and intraoperative UC are better than preoperative UC in predicting the occurrence of postoperative infection complications 10 , 11 , 14 . However, infection complications generally occur within 24 h after surgery, and stones and an intraoperative urine culture cannot provide early warning for clinicians to prevent postoperative infectious complications.…”

Postoperative Urinary Tract Calculi Culture – Is it necessary in Negative Urine Culture Patients?

“…Postoperative calculi culture is not routinely performed in stone surgery cases, previous studies revealed the diverse result. Five studies encourage routine calculi culture examination (Songra et al, 2015;Martov et al, 2014;Gupta et al, 2020;Ashra Mahabani & Kumar, 2022), but two studies suggest the opposite (Osman et al, 2016;Elshal et al, 2014). Songra et al (2015), and Gupta et al (2020) showed the relevancy of calculi culture in urological procedures, but the included cases were all preoperative urine culture status, positive and negative.…”