A study on positive stone culture and its association with rate of sepsis after urological procedures

Abstract

Background: This prospective study is carried out to determine if there is a correlation between urine and/or stone cultures with postoperative sepsis in patients treated for renal and ureteral calculi. And to determine the correlation between different sites of urine sampling, including stones, and also ascertained which is more predictive of urosepsis. Correlation of urosepsis with prognosis and final outcome of patients of urolithiasis. Methods: This prospective study was carried out in Department of surgery, Gandhi medical collage Bhopal and associated Hamidia hospital Bhopal between July 2013 to October 2014. All patients are divided in 4 groups according to their diagnosis. Results: The incidence of renal stone was more in male (N 67) (67%) as compared with female (N 33) (33%) i.e., in the ratio of 2:1. Out of 100 patients 45 cases showed infection in preoperative urine culture, while rest 55 were sterile. Similarly 65 patients were positive for stone culture and rest 35 were sterile. 30 patients had both stone and urine culture positive. Infected urine was more common in females (66.67%). Most common bacteria isolated in urine culture were E. coli (24.44%), Klebsiella (17.77%). While correlating the result of concurrent bacteriological analysis of stones and urine culture, it is evident that same organisms from urine culture and stone culture were isolated in 8 (17.77% of positive urine culture) cases but different organisms in 26 (57.77% positive urine culture) cases. Post operatively 37% (N 37) patient show signs of SIRS out of which 17 patients had both preoperative urine and post-operative stone core culture positive. 14 Patient had only stone core culture positive, 5 pt had only urine culture positivity, and in one patient both culture were negative. Out of 37 patients who had sepsis 31 patients were positive for stone culture while 23 patients were positive for urine culture. The result was significant on chi square test (Observed P value is 0.036). Conclusions: The results of this study suggest that in patients undergoing surgery for urolithiasis, stone cultures are better predictors of urosepsis than bladder urine C and S. Positive stone culture may guide clinicians regarding selection of antibiotics, especially in cases of severe urosepsis.