Characteristics and clinical significance of bacterial colonization of ureteral double-J stents in children

Abstract

To determine the frequency, type of pathogen and clinical significance of bacterial colonization of double-J stents after pyeloplasty in children. The medical files of 82 consecutive children (22 girls, 60 boys) who underwent pyeloplasty at a tertiary pediatric medical center in 2000-2007 were reviewed. Additional inclusion criteria were sterile urine preoperatively and placement of an indwelling double-J stent during surgery. Intravenous gentamicin was administered prior to pyeloplasty and stent removal; cephalexin was administered postoperatively until discharge. Children with a postoperative urinary tract infection (UTI) received full-dose antimicrobial treatment followed by prophylaxis until stent removal. Median patient age at surgery was 11 months (1 month-17.5 years). Forty-nine stents were inserted on the left side, 32 on the right, and one bilaterally. Cultures showed bacterial colonization in 58 cases (70.7%); 15 (25.8%) grew Staphylococcus (coagulase negative and positive). Eight children had febrile UTI postoperatively; in four the stent was colonized by Enterococci and in one by Proteus; three were sterile. There was no statistically significant association between positive stent culture and febrile UTI, patient age or sex, or stent laterality. The study was potentially limited by its observational design, small sample size, and the selective antibiotic treatment of patients with UTI which may have affected stent bacterial resistance. Bacterial colonization is not uncommon in double-J stents retained for several weeks after pyeloplasty, but is usually not clinically significant. Enterococcus is the most frequent pathogen.