Clinical Implications of Stent Culture in Patients with Indwelling Ureteral Stents Prior to Ureteroscopy

Abstract

We determined the ability of urine culture to predict stent culture status and associated infectious pathogens, and evaluated the association between stent culture and post-ureteroscopy sepsis. We queried the prospectively collected database at our institution and identified all patients who underwent ureteroscopy between October 2010 and August 2016 who had a ureteral stent before the operation and from whom urine and stent cultures were obtained. The study end point was post-ureteroscopy sepsis within 48 hours of the procedure. We compared urine and stent culture findings, and performed univariate and multivariate analyses to identify predictors of post-ureteroscopy sepsis. The study group comprised 509 patients with a median age of 56 years, of whom 147 (28.9%) were female. Positive urine cultures were found in 91 patients (17.8%) and positive stent cultures were found in 104 (20.4%). Urine and stent cultures were positive in 48 patients (9.4%), of whom only 24 had identical bacteria in both cultures. The most common pathogens isolated from urine and stent cultures were Escherichia coli in 38.5% and Enterococcus in 18.4%. Sepsis developed in 25 patients (4.9%), including 21 (84%) with a positive stent culture and 14 (59%) with a positive urine culture. On multivariate analysis female gender and positive stent culture were significantly associated with post-ureteroscopy sepsis. Only half of the patients with ureteral stents prior to ureteroscopy, and positive stent and urine cultures had similar pathogens in both cultures. Female gender and positive stent culture were associated with a higher risk of post-ureteroscopy sepsis in this population. Stent culture may direct the proper antibiotic treatment in patients with sepsis after ureteroscopy.