MP26-12 IMPACT OF POSITIVE URINE AND STONE CULTURE ON SEPTIC SHOCK FOLLOWING PERCUTANEOUS NEPHROLITHOTOMY

Abstract

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder II1 Apr 2016MP26-12 IMPACT OF POSITIVE URINE AND STONE CULTURE ON SEPTIC SHOCK FOLLOWING PERCUTANEOUS NEPHROLITHOTOMY Shivanshu Singh, Shrawan Singh, Santosh Kumar, Neelam Taneja, and Arup K Mandal Shivanshu SinghShivanshu Singh More articles by this author , Shrawan SinghShrawan Singh More articles by this author , Santosh KumarSantosh Kumar More articles by this author , Neelam TanejaNeelam Taneja More articles by this author , and Arup K MandalArup K Mandal More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2949AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Septic shock following percutaneous nephrolithotomy (PNL) is a major hurdle in recovery of the patient. Other concerns are emergence of multi-drug resistance (MDR) bacteria and role of routine stone culture for management of septic complications. The study was conducted to evaluate the risk of septic shock in patients with MDR bacteriuria and the utility of stone culture. METHODS In this prospective study, all cases of renal stones undergoing PNL between July, 2014 and September, 2015 were evaluated for their demographic profile, pre-operative and per-operative urine and stone culture and post-operative complications. RESULTS Total 210 patients with renal stone (mean age was 38±14 years) underwent PNL; 64.2% of them were male. Incidence of Systemic Inflammatory Response Syndrome (SIRS), sepsis and septic shock were 29%, 15%, 4% respectively. Total 30(14%) cases had positive stone culture. Out of 55 cases that had positive urine or stone culture, 46 (84%) of them had MDR bacteria. Relative risk of septic shock with positive stone culture and MDR bacterial culture was 4.78 (13.3% vs. 2.78%; p=0.007) and 1.56 (17.4% vs. 11.11%; p=0.65) respectively. Incidence of septic shock was 10 times higher in those who underwent PNL with pre-operative bacteriuria (25% vs. 2.5%; p<0.001). Out of 46 cases who had positive pre-operative urine cultures, 30 (65%) had sterile urine culture following antibiotics and diversion before PNL. The relative risk of septic shock in cases with persistent positive urine culture was 1.5-fold higher as compared to those in whom urine culture became sterile (25% vs. 16.7%; p=0.49). In the latter group, 9 cases had positive stone culture and they had a 1.5 times greater risk of septic shock compared to those with sterile stone cultures (22.2% vs. 14.28%; p=0.5). Twenty out of 30 patients with positive stone culture had positive pre-operative urine culture; 10 had different bacterial genera in urine as compared to stone culture. CONCLUSIONS Pre-operative bacteriuria and positive stone cultures pose a significantly higher risk of post-PCNL septic shock. MDR bacteria per se does not result in significant increase in risk of septic shock. Stone cultures may help in guiding therapy for subsets of patients with septic shock as they may be harboring different bacteria as compared to urine culture. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e358 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Shivanshu Singh More articles by this author Shrawan Singh More articles by this author Santosh Kumar More articles by this author Neelam Taneja More articles by this author Arup K Mandal More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...