1541 INFECTIOUS OUTCOMES IN NEPHROSTOMY DRAINAGE PRIOR TO PERCUTANEOUS NEPHROLITHOTOMY COMPARED TO CONCURRENT ACCESS

Abstract

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopy or Percutaneous Stone Removal (I)1 Apr 20131541 INFECTIOUS OUTCOMES IN NEPHROSTOMY DRAINAGE PRIOR TO PERCUTANEOUS NEPHROLITHOTOMY COMPARED TO CONCURRENT ACCESS Aaron Benson, Trisha Juliano, Ryan Pickens, and Nicole Miller Aaron BensonAaron Benson Nashville, TN More articles by this author , Trisha JulianoTrisha Juliano Nashville, TN More articles by this author , Ryan PickensRyan Pickens Nashville, TN More articles by this author , and Nicole MillerNicole Miller Nashville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3031AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Stone culture and renal pelvic urine cultures have been shown to be better predictors of urosepsis than pre-operative bladder culture. Short-term pre-operative antibiotics have also been shown to reduce the risk of urosepsis after percutaneous nephrolithotomy (PCNL). We hypothesized that establishing percutaneous nephrostomy drainage and treating with renal pelvic urine culture-specific antibiotics prior to PCNL would result in decreased risk of sepsis/systemic inflammatory response syndrome (SIRS) in patient undergoing PCNL, particularly in patients deemed to be at increased infection risk. To that end, we compared PCNL outcomes in patients with prior nephrostomy drainage to those that had percutaneous access performed concurrent with the PCNL. METHODS Data collected included patient age, gender, body mass index, pre-PCNL urine cultures, laterality/location, renal calculi burden size, pelvic urine/stone cultures, length of stay, and SIRS/complications. The data for patients with pre-placed nephrostomy drainage was compared to outcomes regarding PCNL with concurrent access using student's t-test and chi-squared test. RESULTS Between September 2007 and June 2012, 219 patients underwent PCNL. Sixty-seven (30.6%) patients had pre-placed nephrostomy drainage (Group 1) for acute obstruction/infection, lower urinary tract reconstruction, or both, while 152 (69.4%) patients had concurrent percutaneous renal access (Group 2) obtained by the urologist. Group 1 pre-PCNL pelvic and lower urinary tract (LUT) urine cultures were positive in 53.5% and 58.6%, respectively, which was higher than Group 2 (23.1%) (p = 0.0001). Group 1 was treated with pre-operative antibiotics for 13.7 days vs. 6.9 days in Group 2 (p = 0.0001). Stone size was larger in Group 2 than Group 1 (4.1 vs. 3.4 cm; p = 0.022). Stone culture was positive more often in Group 1 than Group 2 (64.2% vs. 25.7%; p = 0.0001). The concordance rate of Group 1 pre-PCNL pelvic urine culture results with stone culture results (30.6%) was higher than those for Group 1 or 2 LUT urine culture (21.4% or 7.3%). There were no SIRS episodes in Group 1 compared to a 6.6% SIRS rate in Group 2 (p = 0.034). CONCLUSIONS Pre-PCNL nephrostomy drainage with renal pelvic urine culture and culture-specific antibiotic treatment decreases sepsis rates in high risk patient populations. Stone culture is important to obtain as our data shows that a significant proportion of patients have positive stone cultures, which would increase the risk of infectious complication. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e632 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aaron Benson Nashville, TN More articles by this author Trisha Juliano Nashville, TN More articles by this author Ryan Pickens Nashville, TN More articles by this author Nicole Miller Nashville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...