1706 SECONDARILY INFECTED NON-STRUVITE UROLITHIASIS: A PROSPECTIVE EVALUATION

Abstract

You have accessJournal of UrologyStone Disease: New Technology/SWL, Ureteroscopic or Percutaneous Stone Removal II1 Apr 20121706 SECONDARILY INFECTED NON-STRUVITE UROLITHIASIS: A PROSPECTIVE EVALUATION Mitra De Cogain, John Lieske, Michael Linnes, Terri Vrtiska, Pritish Tosh, and Amy Krambeck Mitra De CogainMitra De Cogain Rochester, MN More articles by this author , John LieskeJohn Lieske Rochester, MN More articles by this author , Michael LinnesMichael Linnes Rochester, MN More articles by this author , Terri VrtiskaTerri Vrtiska Rochester, MN More articles by this author , Pritish ToshPritish Tosh Rochester, MN More articles by this author , and Amy KrambeckAmy Krambeck Rochester, MN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1643AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Struvite stones are formed by urease-producing pathogens. However, non-struvite stones may be secondarily infected and the causes and consequences in these cases are poorly defined. METHODS Patients undergoing percutaneous nephrolithotomy at Mayo Clinic were recruited for this prospective study. Medical records were reviewed and stones were analyzed using microCT and infrared spectroscopy. A fragment of each stone removed was sent for bacterial culture. Patients were categorized by stone culture results (SC+/-) and whether or not it contained any struvite (ST+/-). Fisher's exact test was used for comparison of proportion. Sterility of intraoperative SC was established with independently collected controls. RESULTS 76 patients were enrolled 13 SC+/ST+, 13 SC+/ST- and 50 SC-/ST-. Control cultures were all negative for microbial growth (n=5), establishing sterility of our technique. History of prior urologic surgery (SC+/ST- (54%), SC+/ST+ (62%), SC-/ST- (52%), p>0.05), diabetes (SC+/ST- (15%), SC+/ST+ (23%), SC-/ST- (20%), p>0.05), neurogenic bladder (SC+/ST- (8%), SC+/ST+ (23%), SC-/ST- (0%), p>0.05), and immunodeficiency (SC+/ST- (23%), SC+/ST+ (8%), SC-/ST- (14%), p>0.05) was similar between the groups. Among patients with metabolic evaluations, hypocitraturia was found in 5/10 (50%) SC+/ST- patients, 3/6 (50%) SC+/ST+ patients, and 9/38 (24%) of SC-/ST- patients (p>0.05). Culture results from SC+ patients are outlined in Table 1. Table 1. Culture results from stone-culture positive, non-struvite stone formers and stone-culture positive, struvite stone formers (data presented as number of patients with microbial growth). Pathogen Urease production Citrate hydrolysis SC+/ST- patients (n=13)⁎ SC+/ST+ patients (n=13)⁎ GRAM NEGATIVE Pseudomonas + + 2 1 Escherichia coli - - 4 0 Klebsiella + + 1 0 Proteus + +/- 0 3 Providencia +/- + 0 1 Enterobacter - + 1 0 GRAM POSITIVE Enterococcus - + 3 2 Micrococcus +/- - 1 0 Streptococcus - n/a 1 1 Aerococcus - n/a 0 1 Staphylococcus +/- n/a 1 5 Corynebacterium - - 2 0 Propionibacterium - + 1 0 Propionimicrobium n/a n/a 0 1 OTHER Ureaplasma + n/a 1 1 Mycoplasma + n/a 1 0 Candida - - 0 1 Gardnerella - n/a 1 0 ⁎ Some patients grew multiple organisms. n/a - Not Available. CONCLUSIONS Secondarily infected stones may be more common than previously appreciated, and were detected in approximately 20% of this cohort with relatively large stones requiring surgical procedures. Prior urologic procedures, diabetes, neurogenic bladder and immunocompromised status were not associated with stone culture positivity. Approximately 50% of cultured organisms possessed urease and another 40% citrate lyase activity. The role of bacterial infection in stone formation merits further study. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byViers B, Cockerill P, Mehta R, Bergstralh E and Krambeck A (2014) Extended Antimicrobial Use in Patients Undergoing Percutaneous Nephrolithotomy and Associated Antibiotic Related ComplicationsJournal of Urology, VOL. 192, NO. 6, (1667-1672), Online publication date: 1-Dec-2014. Volume 187Issue 4SApril 2012Page: e688-e689 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mitra De Cogain Rochester, MN More articles by this author John Lieske Rochester, MN More articles by this author Michael Linnes Rochester, MN More articles by this author Terri Vrtiska Rochester, MN More articles by this author Pritish Tosh Rochester, MN More articles by this author Amy Krambeck Rochester, MN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...