Urinary tract infection and antibiotic use around ureteral stent insertion for urolithiasis
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ORIGINAL ARTICLE
Urinary tract infection and antibiotic use around ureteral stent insertion for urolithiasis Bérénice Souhail 1 & Patrick Charlot 2 & Gilles Deroudilhe 3 & Yves Coblentz 2 & Gregory Pierquet 3 & Pierre Gimel 4 & Nathalie Challut 4 & Thierry Levent 5 & Stéphane Cusumano 6 & Véronique Dautezac 6 & Pierre-Marie Roger 1,7,8 Received: 3 February 2020 / Accepted: 15 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Urolithiasis is the main indication for a ureteral JJ stent. Our aim was to determine the incidence of urinary tract infections (UTIs) after a JJ stent for urolithiasis, with an emphasis on antibiotic use. Prospective, multicenter, cohort study over a 4-month period including all of the patients with urolithiasis requiring JJ stent insertion. The clinical and microbiological data and therapeutic information were recorded until removal of the JJ stent. Two hundred twenty-three patients at five French private hospitals were included. A urine culture was performed for 187 patients (84%) prior to insertion of a JJ stent, 36 (19%) of which were positive. One hundred thirty patients (58%) received an antibiotic therapy during surgery: 74 (33%) prophylaxis and 56 (25%) empirical antibiotic therapy, comprising 17 different regimens. The rate of prophylaxis varied according to the center, from 0 to 70%. A total of 208 patients were followed-up until removal of the first stent. The rate of UTIs was 6.3% (13/208); 8.1% of the patients who did not receive a prophylaxis had a UTI versus 1.4% of those who did receive a prophylaxis (p = 0.057). Seven empirical antibiotic regimens were used to treat these 13 patients. Another large panel of antibiotic prescriptions was observed at the time of JJ stent removal. The incidence of a UTI after JJ stent insertion for urolithiasis was 6.3%, in part due to a lack of prophylaxis. An unwarranted diversity of antibiotic use was observed at each step of care. Keywords Urolithiasis . Ureteral stent . Urinary tract infection . Healthcare-associated infection . Antibiotic therapy
Introduction
* Bérénice Souhail [email protected] 1
Réso-Infectio-PACA-Est, Nice, France
2
Elsan, Clinique Inkermann, 84 Rte d’Aiffres, 79000 Niort, France
3
Elsan, Clinique Saint Augustin, 114 Ave d’Arès, 33000 Bordeaux, France
4
Elsan, Clinique Saint-Roch 5 Rue Ambroise Croizat, 66330 Cabestany, France
5
Elsan, Clinique Vauban, 10 Avenue Vauban, 59300 Valenciennes, France
6
Elsan, Clinique du Sidobre, Chemin de St Hyppolyte, 81100 Castres, France
7
Elsan, Clinique Les Fleurs,, Avenue Frédéric Mistral, 83190 Ollioules, France
8
Faculté de Médecine, Université Côte d’Azur, 28 Avenue de Valombrose, 06107 Nice, France
The first indication for use of a ureteral stent (or a double pigtail stent or JJ stent) is complications from urolithiasis, making it a daily occurrence for urological surgeons [1]. The complications of urolithiasis are urinary tract infection (UTI), and/or anuria, and/or intolerable pain. These are urological emergencies as they req
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