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Erschienen in: International Urology and Nephrology 1/2017

15.11.2016 | Urology - Original Paper

Concordance of renal stone culture: PMUC, RPUC, RSC and post-PCNL sepsis—a non-randomized prospective observation cohort study

verfasst von: Annerleim Walton-Diaz, José Ignacio Vinay, Jaime Barahona, Pieter Daels, Mariano González, Juan Pablo Hidalgo, Cristian Palma, Pablo Díaz, Alfredo Domenech, Rodrigo Valenzuela, Fernando Marchant

Erschienen in: International Urology and Nephrology | Ausgabe 1/2017

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Abstract

Introduction

Between 5 and 10% of patients undergoing percutaneous nephrolithotomy (PCNL) develop postoperative sepsis 1, 2. Strategies to prevent infectious complications are based on information provided by preoperative midstream urine cultures (PMUC). The aim of this study is to evaluate the concordance of the microbiologic findings of PMUC, cultures of the renal stone (RSC) and urine obtained directly from the renal pelvis (RPUC) in patients undergoing PCNL.

Materials and methods

This is a multicenter prospective study. The study included all patients who underwent PCNL from May 2013 to July 2015 in three academic hospitals. All patients underwent a PMUC. Samples for RPUC were obtained by renal puncture for PCNL. Stone fragments extracted during the procedure were sent for culture (RSC). Clinical variables, stone configuration, burden and microbiology reports of cultures were recorded. We analyzed concordance between cultures and association with infectious complications.

Results

One hundred and twenty-two patients underwent PCNL. Twenty-four percent had positive culture, 3.2% (4/122) PMUC, 14.7% (18/122) RPUC and 13.9% (17/122) RSC. Positive PMUC demonstrated multidrug-susceptible Escherichia coli and Staphylococcus aureus, while RPUC showed multidrug-resistant pathogens and/or fungus. Seven patients (5.7%) developed postoperative infectious complications prior to discharge. There was a weak correlation between PMUC and intraoperative urine cultures (RPUC and RSC). Concordance rate between RPUC and RSC was 83.3%. The most common isolated pathogens were multidrug-resistant bacteria or fungus.

Conclusions

PMUC did not reflect the microbiological environment found in stones and urine directly obtained from the renal pelvis. Patients with postoperative infectious complications had negative PMUC with positive RPUC or RSC. RPUC and RSC can help guide prompt and appropriate antibiotic treatment for patients who develop postoperative infectious complications after PCNL.
Literatur
1.
Zurück zum Zitat Skolarikos A, Alivizatos G, de la Rosette JJ (2005) Percutaneous nephrolithotomy and its legacy. Eur Urol 47:22–28CrossRefPubMed Skolarikos A, Alivizatos G, de la Rosette JJ (2005) Percutaneous nephrolithotomy and its legacy. Eur Urol 47:22–28CrossRefPubMed
2.
Zurück zum Zitat Draga RO, Kok ET, Sorel MR, Bosch RJ, Lock TM (2009) Percutaneous nephrolithotomy: factors associated with fever after the first postoperative day and systemic inflammatory response syndrome. J Endourol 23:921–927CrossRefPubMed Draga RO, Kok ET, Sorel MR, Bosch RJ, Lock TM (2009) Percutaneous nephrolithotomy: factors associated with fever after the first postoperative day and systemic inflammatory response syndrome. J Endourol 23:921–927CrossRefPubMed
3.
Zurück zum Zitat Labate G et al (2011) The percutaneous nephrolithotomy global study: classification of complications. J Endourol 25:1275–1280CrossRefPubMed Labate G et al (2011) The percutaneous nephrolithotomy global study: classification of complications. J Endourol 25:1275–1280CrossRefPubMed
4.
Zurück zum Zitat Michel MS, Trojan L, Rassweiler JJ (2007) Complications in percutaneous nephrolithotomy. Eur Urol 51:899–906; discussion 906 Michel MS, Trojan L, Rassweiler JJ (2007) Complications in percutaneous nephrolithotomy. Eur Urol 51:899–906; discussion 906
5.
Zurück zum Zitat Sahin A et al (2000) Percutaneous nephrolithotomy in older children. J Pediatr Surg 35:1336–1338CrossRefPubMed Sahin A et al (2000) Percutaneous nephrolithotomy in older children. J Pediatr Surg 35:1336–1338CrossRefPubMed
6.
Zurück zum Zitat Scherz HC, Parsons CL (1987) Prophylactic antibiotics in urology. Urol Clin North Am 14:265–271PubMed Scherz HC, Parsons CL (1987) Prophylactic antibiotics in urology. Urol Clin North Am 14:265–271PubMed
7.
Zurück zum Zitat Dogan HS et al (2002) Antibiotic prophylaxis in percutaneous nephrolithotomy: prospective study in 81 patients. J Endourol 16:649–653CrossRefPubMed Dogan HS et al (2002) Antibiotic prophylaxis in percutaneous nephrolithotomy: prospective study in 81 patients. J Endourol 16:649–653CrossRefPubMed
8.
Zurück zum Zitat Lee WJ et al (1987) Complications of percutaneous nephrolithotomy. AJR Am J Roentgenol 148:177–180CrossRefPubMed Lee WJ et al (1987) Complications of percutaneous nephrolithotomy. AJR Am J Roentgenol 148:177–180CrossRefPubMed
9.
Zurück zum Zitat Sweeney DA, Danner RL, Eichacker PQ, Natanson C (2008) Once is not enough: clinical trials in sepsis. Intensive Care Med 34:1955–1960CrossRefPubMed Sweeney DA, Danner RL, Eichacker PQ, Natanson C (2008) Once is not enough: clinical trials in sepsis. Intensive Care Med 34:1955–1960CrossRefPubMed
10.
Zurück zum Zitat Koras O et al (2015) Risk factors for postoperative infectious complications following percutaneous nephrolithotomy: a prospective clinical study. Urolithiasis 43:55–60CrossRefPubMed Koras O et al (2015) Risk factors for postoperative infectious complications following percutaneous nephrolithotomy: a prospective clinical study. Urolithiasis 43:55–60CrossRefPubMed
11.
Zurück zum Zitat Mariappan P, Smith G, Bariol SV, Moussa SA, Tolley DA (2005) Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy: a prospective clinical study. J Urol 173:1610–1614CrossRefPubMed Mariappan P, Smith G, Bariol SV, Moussa SA, Tolley DA (2005) Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy: a prospective clinical study. J Urol 173:1610–1614CrossRefPubMed
12.
Zurück zum Zitat Ratzinger F et al (2015) Sepsis biomarkers in neutropaenic systemic inflammatory response syndrome patients on standard care wards. Eur J Clin Invest 45:815–823CrossRefPubMed Ratzinger F et al (2015) Sepsis biomarkers in neutropaenic systemic inflammatory response syndrome patients on standard care wards. Eur J Clin Invest 45:815–823CrossRefPubMed
13.
Zurück zum Zitat Deshmukh S, Sternberg K, Hernandez N, Eisner BH (2015) Compliance with American Urological Association guidelines for post-percutaneous nephrolithotomy antibiotics does not appear to increase rates of infection. J Urol 194:992–996CrossRefPubMed Deshmukh S, Sternberg K, Hernandez N, Eisner BH (2015) Compliance with American Urological Association guidelines for post-percutaneous nephrolithotomy antibiotics does not appear to increase rates of infection. J Urol 194:992–996CrossRefPubMed
14.
Zurück zum Zitat Opal SM et al (1999) Relationship between plasma levels of lipopolysaccharide (LPS) and LPS-binding protein in patients with severe sepsis and septic shock. J Infect Dis 180:1584–1589CrossRefPubMed Opal SM et al (1999) Relationship between plasma levels of lipopolysaccharide (LPS) and LPS-binding protein in patients with severe sepsis and septic shock. J Infect Dis 180:1584–1589CrossRefPubMed
15.
Zurück zum Zitat McAleer IM, Kaplan GW, Bradley JS, Carroll SF, Griffith DP (2003) Endotoxin content in renal calculi. J Urol 169:1813–1814CrossRefPubMed McAleer IM, Kaplan GW, Bradley JS, Carroll SF, Griffith DP (2003) Endotoxin content in renal calculi. J Urol 169:1813–1814CrossRefPubMed
16.
Zurück zum Zitat McAleer IM, Kaplan GW, Bradley JS, Carroll SF (2002) Staghorn calculus endotoxin expression in sepsis. Urology 59:601CrossRefPubMed McAleer IM, Kaplan GW, Bradley JS, Carroll SF (2002) Staghorn calculus endotoxin expression in sepsis. Urology 59:601CrossRefPubMed
17.
Zurück zum Zitat Tefekli A et al (2008) Classification of percutaneous nephrolithotomy complications using the modified clavien grading system: looking for a standard. Eur Urol 53:184–190CrossRefPubMed Tefekli A et al (2008) Classification of percutaneous nephrolithotomy complications using the modified clavien grading system: looking for a standard. Eur Urol 53:184–190CrossRefPubMed
18.
Zurück zum Zitat Rao PN, Dube DA, Weightman NC, Oppenheim BA, Morris J (1991) Prediction of septicemia following endourological manipulation for stones in the upper urinary tract. J Urol 146:955–960PubMed Rao PN, Dube DA, Weightman NC, Oppenheim BA, Morris J (1991) Prediction of septicemia following endourological manipulation for stones in the upper urinary tract. J Urol 146:955–960PubMed
19.
Zurück zum Zitat Roushani A et al (2014) Intra-operative stone culture as an independent predictor of systemic inflammatory response syndrome after percutaneous nephrolithotomy. Urolithiasis 42:455–459CrossRefPubMed Roushani A et al (2014) Intra-operative stone culture as an independent predictor of systemic inflammatory response syndrome after percutaneous nephrolithotomy. Urolithiasis 42:455–459CrossRefPubMed
20.
Zurück zum Zitat Gutierrez J et al (2013) Urinary tract infections and post-operative fever in percutaneous nephrolithotomy. World J Urol 31:1135–1140CrossRefPubMed Gutierrez J et al (2013) Urinary tract infections and post-operative fever in percutaneous nephrolithotomy. World J Urol 31:1135–1140CrossRefPubMed
21.
Zurück zum Zitat Shigeta M, Hayashi M, Igawa M (1995) A clinical study of upper urinary tract calculi treated with extracorporeal shock wave lithotripsy: association with bacteriuria before treatment. Urol Int 54:214–216CrossRefPubMed Shigeta M, Hayashi M, Igawa M (1995) A clinical study of upper urinary tract calculi treated with extracorporeal shock wave lithotripsy: association with bacteriuria before treatment. Urol Int 54:214–216CrossRefPubMed
22.
Zurück zum Zitat Dasgupta R, Grabe M (2009) Preoperative antibiotics before endourologic surgery: current recommendations. J Endourol 23:1567–1570CrossRefPubMed Dasgupta R, Grabe M (2009) Preoperative antibiotics before endourologic surgery: current recommendations. J Endourol 23:1567–1570CrossRefPubMed
23.
Zurück zum Zitat Turk C et al (2016) EAU guidelines on interventional treatment for urolithiasis. Eur Urol 69:475–482CrossRefPubMed Turk C et al (2016) EAU guidelines on interventional treatment for urolithiasis. Eur Urol 69:475–482CrossRefPubMed
24.
Zurück zum Zitat Jou YC et al (2015) Contributing factors for fever after tubeless percutaneous nephrolithotomy. Urology 85:527–530CrossRefPubMed Jou YC et al (2015) Contributing factors for fever after tubeless percutaneous nephrolithotomy. Urology 85:527–530CrossRefPubMed
25.
Zurück zum Zitat Patel N et al (2015) Multidrug resistant bacteriuria before percutaneous nephrolithotomy predicts for postoperative infectious complications. J Endourol 29:531–536CrossRefPubMed Patel N et al (2015) Multidrug resistant bacteriuria before percutaneous nephrolithotomy predicts for postoperative infectious complications. J Endourol 29:531–536CrossRefPubMed
26.
Zurück zum Zitat Gonen M, Turan H, Ozturk B, Ozkardes H (2008) Factors affecting fever following percutaneous nephrolithotomy: a prospective clinical study. J Endourol 22:2135–2138CrossRefPubMed Gonen M, Turan H, Ozturk B, Ozkardes H (2008) Factors affecting fever following percutaneous nephrolithotomy: a prospective clinical study. J Endourol 22:2135–2138CrossRefPubMed
27.
Zurück zum Zitat Margel D et al (2006) Clinical implication of routine stone culture in percutaneous nephrolithotomy—a prospective study. Urology 67:26–29CrossRefPubMed Margel D et al (2006) Clinical implication of routine stone culture in percutaneous nephrolithotomy—a prospective study. Urology 67:26–29CrossRefPubMed
28.
Zurück zum Zitat Shoshany O et al (2015) Percutaneous nephrolithotomy for infection stones: what is the risk for postoperative sepsis? A retrospective cohort study. Urolithiasis 43:237–242CrossRefPubMed Shoshany O et al (2015) Percutaneous nephrolithotomy for infection stones: what is the risk for postoperative sepsis? A retrospective cohort study. Urolithiasis 43:237–242CrossRefPubMed
29.
Zurück zum Zitat de la Rosette J et al (2011) The clinical research office of the endourological society percutaneous nephrolithotomy global study: indications, complications, and outcomes in 5803 patients. J Endourol 25:11–17CrossRefPubMed de la Rosette J et al (2011) The clinical research office of the endourological society percutaneous nephrolithotomy global study: indications, complications, and outcomes in 5803 patients. J Endourol 25:11–17CrossRefPubMed
30.
Zurück zum Zitat Korets R, Graversen JA, Kates M, Mues AC, Gupta M (2011) Post-percutaneous nephrolithotomy systemic inflammatory response: a prospective analysis of preoperative urine, renal pelvic urine and stone cultures. J Urol 186:1899–1903CrossRefPubMed Korets R, Graversen JA, Kates M, Mues AC, Gupta M (2011) Post-percutaneous nephrolithotomy systemic inflammatory response: a prospective analysis of preoperative urine, renal pelvic urine and stone cultures. J Urol 186:1899–1903CrossRefPubMed
Metadaten
Titel
Concordance of renal stone culture: PMUC, RPUC, RSC and post-PCNL sepsis—a non-randomized prospective observation cohort study
verfasst von
Annerleim Walton-Diaz
José Ignacio Vinay
Jaime Barahona
Pieter Daels
Mariano González
Juan Pablo Hidalgo
Cristian Palma
Pablo Díaz
Alfredo Domenech
Rodrigo Valenzuela
Fernando Marchant
Publikationsdatum
15.11.2016
Verlag
Springer Netherlands
Erschienen in
International Urology and Nephrology / Ausgabe 1/2017
Print ISSN: 0301-1623
Elektronische ISSN: 1573-2584
DOI
https://doi.org/10.1007/s11255-016-1457-y

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