Abstract
Background: Urosepsis means a severe infection of urinary tract (UTI) and/or male genital tract (prostate) with features consistent with systemic inflammatory response syndrome. UTI may occur among all the age groups and produce a broad range of clinical syndromes ranging from asymptomatic bacteriuria to acute pyelonephritis with gram negative sepsis to septic shock. It is estimated that the mortality rate due to urosepsis ranges from 30 to 40 p.c respectively. Urosepsis may also cause multiple organ dysfunction, hypoperfusion or hypotension. Urosepsis due to percutaneous nephrolithotomy may be catastrophic despite prophylactic antibiotic coverage and negative midstream urine culture and sensitivity testing (C&S) and bacteria in the stone can be responsible for systemic infection. The aim of the study is to compare bladder urine (culture & sensitivity) and collecting system urine and stone (culture and sensitivity) in predicting urosepsis following percutaneous nephrolithotomy. Subjects and Methods: A hospital-based, analytical prospective clinical study was conducted among thirty cases who were present during the study period and had undergone percutaneous nephrolithotomy (PCNL). Cases were included irrespective of gender with renal calculi in whom percutaneous nephrolithotomy was about to be done at Narayana Medical College & Hospital, Chintareddypalem, Nellore, Andhra Pradesh during 1st February 2014 to 31st January 2015. Data collected was divided into three main groups Midstream urine (C&S); Pelvic urine (C&S); and Stone (C&S) respectively. Data obtained was entered in Microsoft Excel-2013 and analyzed in SPSS version-22 trial. Appropriate statistical tests were applied and p-value less than 0.05 was considered as significant. Results: Bladder urine (C&S) was positive in 3/30 (10.00%) patients, Pelvic urine (C&S) in 5/30 (16.66 %) patients and Stone (C&S) in 8/30 (26.66 %) patients. Most of the infected specimens grew Escherichia coli followed by pseudomonas, klebsiella, enterococcus. Systemic Inflammatory Response Syndrome (SIRS) was reported among 26.7 p.c (8) of the patients. In one patient (3.33%) septic shock developed but no deaths were reported. Conclusion: Stone (C&S) and Pelvic urine (C&S) are better predictors of urosepsis than Bladder urine (C&S).
Highlights
[1] UTI may occur among all the age groups and produce a broad range of clinical syndromes ranging from asymptomatic bacteriuria to acute pyelonephritis with gram negative sepsis to septic shock
[12] Urosepsis due to percutaneous nephrolithotomy may be catastrophic despite prophylactic antibiotic coverage and negative midstream urine culture and sensitivity testing (C&S) and bacteria in the stone can be responsible for systemic infection
A hospital-based, analytical prospective clinical study was conducted among thirtycases who were present during the study period and had undergone percutaneous nephrolithotomy (PCNL)
Summary
Urosepsis means a severe infection of urinary tract (UTI) and/or male genital tract (prostate) with features consistent with systemic inflammatory response syndrome. [1] UTI may occur among all the age groups and produce a broad range of clinical syndromes ranging from asymptomatic bacteriuria to acute pyelonephritis with gram negative sepsis to septic shock. [2] Urosepsis may cause multiple organ dysfunction, hypoperfusion or hypotension. [2] A severe sepsis condition may be usually associated with abdominal and pulmonary infections with UTIs which account for about 5 p.c of the cases. [3] About 40 p.c of the urinary tract infections were due to nosocomial infections. [4] About 25 p.c of the sepsis cases originate from urogenital system. [5] A percutaneous nephrolithotomy is a minimally invasive surgical procedure performed to treat patients with a large and complex renal calculi. [6]Urosepsis is a complication which occur after a percutaneous nephrolithotomy among 0.3 to 2.5 p.c cases. [7] Staghorn urinary calculi may harbor bacteria. Reddy & Reddy: Urosepsis Following Percutaneous Nephrolithotomy common pathogens causing UTIs (and in turn urosepsis) are Escherichia coli (50%), Proteus (15%), Enterobacter (15%), Klebsiella (15%), Pseudomonas aeruginosa (5%) and grampositive bacteria (15%) respectively. Urosepsis due to percutaneous nephrolithotomy may be catastrophic despite prophylactic antibiotic coverage and negative midstream urine culture and sensitivity testing (C&S) and bacteria in the stone can be responsible for systemic infection. The aim of the study is to compare bladder urine (culture & sensitivity) and collecting system urine and stone (culture and sensitivity) in predicting urosepsis following percutaneous nephrolithotomy. Conclusion: Stone (C&S) and Pelvic urine (C&S) are better predictors of urosepsis than Bladder urine (C&S)
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