Feasibility and relevance of urine culture during stone fragmentation in patients undergoing percutaneous nephrolithotom
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TOPIC PAPER
Feasibility and relevance of urine culture during stone fragmentation in patients undergoing percutaneous nephrolithotomy and retrograde intrarenal surgery: a prospective study E. De Lorenzis1,2 · L. Boeri1 · A. Gallioli1 · M. Fontana1 · S. P. Zanetti1 · F. Longo1 · R. Colombo3 · M. Arghittu3 · S. Piconi4 · G. Albo1,2 · A. Trinchieri5 · E. Montanari1,2 Received: 31 January 2020 / Accepted: 22 July 2020 © The Author(s) 2020
Abstract Purpose We evaluated if, during lithotripsy, bacteria may be detected in the irrigation fluid of percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). The concordance between urine culture from stone fragmentation (SFUC), bladder (BUC), renal pelvic (RPUC) and stone (SC) was analyzed. We also assessed the correlation between variables and cultures and their association with systemic inflammatory response syndrome (SIRS) and of a positive SC. Methods We included 107 patients who underwent PCNL (n = 53) and RIRS (n = 54) from January 2017 to May 2018. Samples for RPUC were obtained by renal catheterization. Stone fragments and irrigation fluid sample were sent for culture. Results SFUC was positive in 17 (15.9%), BUC in 22 (20.6%), RPUC in 26 (24.3%) and SC in 30 patients (28%). The concordance between SFUC and SC was the highest among all cultures: 94.1%. SFUC and SC grew identical microorganisms in 15/17 (88.2%) patients. Out of 17 (15.9%) patients with SIRS, 8 (7.5%) had sepsis. SFUC had the highest PPV and specificity to detect positive SC and SIRS. Previous urinary tract infection, a preoperative nephrostomy, stone diameter and composition, staghorn calculi, PCNL, positive BUC, RPUC and SFUC were predictors of infected stone. Variables that indicate complex stones, complex PCNL and an infection of the upper tract were associated with SIRS. Conclusion SFUC is technically feasible, easy to retrieve and to analyze. The spectrum of SFUC potential application in clinical practice is when is not possible to perform a SC, e.g. complete dusting or during micro-PCNL. Keywords Urinary tract infection · Urolithiasis · Culture media · Ureteroscopy · Percutaneous nephrolithotomy · Sepsis
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00345-020-03387-6) contains supplementary material, which is available to authorized users. * E. De Lorenzis [email protected] 1
Department of Urology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via della Commenda 15, 20122 Milan, Italy
2
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
3
Microbiology and Virology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
4
Infectious Diseases Department, ASST Fatebenefratelli-Sacco, Milan, Italy
5
University of Milan, Milan, Italy
Infections are the most common complications of endourological procedures for stones. Among all patients submitted to percutaneous nephrolithotomy (PCNL), 10–30% develop fever, 35% syst
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