Multidrug resistant bacteriuria before percutaneous nephrolithotomy predicts for postoperative infectious complications.

PD28-01 DOES PRE-OPERATIVE MULTI-DRUG RESISTANT URINE CULTURE PREDICT INFECTIOUS COMPLICATIONS AFTER PERCUTANEOUS NEPHROLITHOTOMY?

To determine the perioperative risk factors for postoperative infections among patients undergoing flexible uretero-renoscopy with laser lithotripsy (FURSLL). In addition, the resistance patterns of pathogens isolated from positive preoperative urine cultures were investigated. We retrospectively reviewed data from 492 consecutive patients who had undergone FURSLL for stone disease in our department. Postoperative infection was defined as fever (? 38°C) with pyuria (? 10 white blood cells per high power field), or systemic inflammatory response syndrome, or sepsis. Pre-operative and intra-operative characteristics between patients with and without postoperative infectious complications were compared using univariate analyses. Significant variables on univariate analyses were included in a multivariatelogistic regression analysis to evaluate risk factors associated with postoperative infection following FURSLL. 42 (8.5%) of 492 patients had postoperative infectious complications after FURSLL. 59 (12%) of 492 patients had a positive preoperative urine culture. 19 (32.2% of 59) patients had multidrug resistance (MDR) isolates recovered from positive preoperative urine cultures. 75% (9/12 cultures) of the positive preoperative urine cultures of patients in whom a postoperative infectious complication developed consisted of gram-negative pathogens. On multivariate analysis positive preoperative MDR urine culture (OR:4.75;95%CI:1.55-14.56; P = .006) was found to be significant with the dependent variable as the postoperative infectious complications despite appropriate preoperative antibiotic therapy. We found that positive preoperative MDR urine culture is a significant risk factor for infectious complications after FURSLL. Our findings point to the need for further research on assessment of risk factors forMDR infections to reduce the rate of postoperative infectious complications.

Objective: To report the incidence and risk factors of urosepsis after ureteroscopic lithotripsy (URSL). Patients and Methods: We retrospectively reviewed 1,421 patients who underwent URSL for ureteral calculi between July 2015 and June 2018 at our department to identify factors predicting postoperative urosepsis. Demographic characteristics, clinical data, operative information, and complications were compared, and risk factors of postoperative urosepsis were identified and analyzed. Results: Of the 1,421 patients treated with URSL using holmium: yttrium-aluminum-garnet laser, 12 (0.8%) developed a urosepsis after operation. The positive preoperative multidrug resistance (MDR) urine culture and operative duration were statistically different between those who did and did not develop a urosepsis (4.61 vs. 25%, p = 0.017; 70 vs. 62 min, p < 0.001). However, patient age, sex, body mass index, diabetes mellitus, history of urolithiasis, positive preoperative urine cultures, stone size and location, degree of hydronephrosis, and prior stent placement were similar in 2 groups. Multivariate analysis revealed that positive preoperative MDR urine culture and long operation duration significantly increased the risk of postoperative urosepsis (OR 5.090, 95% CI 1.312–19.751, p = 0.019; OR 1.034, 95% CI 1.004–1.063; p = 0.024). Matched-pair analysis demonstrated that positive preoperative MDR urine culture and operation duration were significantly associated with postoperative urosepsis (OR 15.77, 95% CI 1.033–240.7, p = 0.047; OR 1.087, 95% CI 1.011–1.169, p = 0.025). Conclusions: Patients with positive preoperative MDR urine culture or long operation duration had a higher risk of developing urosepsis after URSL. When treating patients who present with positive preoperative MDR urine culture or long operation duration, urologists should be vigilant and aware of the potential risk of urosepsis.

Objective: To evaluate the outcomes and complications of percutaneous nephrolithotomy (PCNL) in patients with multidrug resistant (MDR) urine cultures in comparison with those with normal urine cultures. Materials and Methods: A retrospective cohort study was completed in patients who underwent PCNL at Maharaj Nakorn Chiang Mai Hospital between January, 2019 and August, 2021. The medical record charts of patients were reviewed and divided into 2 groups: those with a preoperative positive multidrug resistant culture (MDR, n=37) and those with a negative urine culture (No MDR, n=73). The following data were collected: demographics, size of stones, intraoperative data, preoperative urine cultures and postoperative complications. Association between factors and postoperative complications after PNCL were identified using a binary logistic regression model. Results: Sepsis complications occurred in 8.2% of the patients (No MDR, n=2, MDR, n=7). The results of the multivariate analysis demonstrated a significant association between a positive preoperative MDR urine culture and postoperative sepsis complications (odds ratio (OR) = 15.21, 95%CI 1.59-145.35, p = 0.018). Conversely, female patients exhibited a decreased risk in comparison to male patients (OR 0.03, 95%CI 0.001-0.75, p = 0.003). Conclusion: The prevalence of positive MDR bacteriuria in patients who underwent PCNL in Maharaj Nakorn Chiang Mai Hospital was relatively high. The female gender exhibited a prophylactic effect, while a positive MDR urine culture emerged as a significant risk factor for postoperative complications associated with sepsis, even in the presence of appropriately administered preoperative prophylactic antibiotics.

BackgroundThe intestinal epithelial barrier allows absorption of dietary nutrients and prevents passage of pathogens and toxins into the body. Severe insults have a negative impact on the intestinal environment, which may decrease intestinal barrier function and cause bacterial translocation. Bacterial translocation, which can cause infectious complications, is defined as the passage of microbes from the gastrointestinal tract across the mucosal barrier to extraintestinal sites. The aim of this study was to investigate the correlation between concentrations of preoperative fecal organic acids and the occurrence of postoperative infectious complications in patients with esophageal cancer.MethodsFifty-five patients with esophageal cancer who underwent esophagectomy were enrolled in this study. Perioperative synbiotics were administered to all patients. Perioperative clinical characteristics and concentrations of preoperative fecal organic acids were compared between patients with and without postoperative infectious complications.ResultsPostoperative infectious complications occurred in 10 patients. In patients with complications, the concentrations of acetic acid and propionic acid were significantly lower than in patients without complications (p = 0.044 and 0.032, respectively). The concentration of butyric acid was nonsignificantly lower in patients with complications, while the concentration of lactic acid was nonsignificantly higher. The calculated gap between the concentrations of fecal acetic acid plus propionic acid plus butyric acid minus lactic acid was significantly lower in patients with complications. Multivariate analysis revealed that a low gap between acetic acid plus propionic acid plus butyric acid minus lactic acid was an independent risk factor for postoperative infectious complications (p = 0.027).ConclusionsPreoperative fecal concentrations of organic acids had a clinically important impact on the occurrence of postoperative infectious complications in patients with esophageal cancer. To reduce postoperative infectious complications, it may be useful to modulate the intestinal environment and maintain concentrations of fecal organic acids before surgery.

Objectives:Percutaneous nephrolithotomy (PCNL) carries a small risk of postoperative sepsis due to the liberation of bacteria into the patients’ bloodstream during stone fragmentation. The study aims to identify the incidence of post-PCNL sepsis in our center, as well as to delineate perioperative characteristics associated with increased rates of sepsis.Materials and Methods:We performed a retrospective review on all PCNLs performed in our center between July 2012 and June 2017, with emphasis on preoperative urine results, intra-operative findings, and postoperative septic complications.Results:Among 425 cases of PCNL performed, 16 (3.76%) developed sepsis postoperatively. Patients with positive preoperative urine cultures were almost four times as likely to develop post-PCNL sepsis compared to those with negative cultures (8.41% vs. 2.2%, P = 0.004). Among patients with positive urine leukocytes and positive urine cultures, the presence of Staghorn calculi and multiple PCNL punctures both predicted significantly higher risks of postoperative sepsis. In contrast, diabetes mellitus and preoperative stenting were not found to be associated with a greater risk of post-PCNL sepsis.Conclusions:Patients who had positive preoperative urine leukocytes and/or cultures, and either harbor Staghorn calculi or are deemed to require more than one puncture on PCNL, were at an increased risk of developing post-PCNL sepsis. Such at-risk patients should be identified preoperatively, given aggressive perioperative antibiotic treatment, and monitored closely for septic complications during the convalescence period.

To analyze the risk factors for complications in patients with struvite stones following percutaneous nephrolithotomy (PCNL) or flexible ureteroscopy (fURS), and to establish a nomogram for postoperative complications in patients following PCNL. A retrospective analysis was conducted on patients with struvite stones after PCNL and fURS at the Department of Urology, Peking University People's Hospital, from January 2012 to March 2022. The common pathogens and antimicrobial susceptibilities in preoperative midstream urine culture were analyzed. Logistic regression analyses were used to evaluate the risk factors. Receiver-operating characteristic (ROC) curve, calibration plots, and decision curve analysis (DCA) were used to assess the discrimination, accuracy, and practicability of the nomogram. 332 patients with struvite stones received one-stage PCNL or fURS, including 243 cases of PCNL and 89 cases of fURS. 72 patients (21.69%) developed postoperative complications. The most common pathogens in preoperative urine cultures were Escherichia coli, Proteus mirabilis, and Enterococcus faecalis. Multivariate logistic regression analysis showed that preoperative hemoglobin (OR = 0.981, P = 0.042), staghorn stone (OR = 4.226, P = 0.037), and positive preoperative midstream urine culture (OR = 2.000, P = 0.043) were independent risk factors for postoperative complications in patients following PCNL. The nomogram showed good performance in discrimination, accuracy, and applicability. Preoperative hemoglobin, staghorn stone, and positive preoperative midstream urine culture were independent risk factors for postoperative complications in patients with struvite stones following PCNL. A nomogram was developed to predict the probability of postoperative complications.

To investigate gender-related predictors of infectious complications after percutaneous nephrolithotomy (PCNL) in a large cohort of patients with kidney stones. We retrospectively analysed data from 492 consecutive patients who under-went PCNL at a single tertiary-referral academic center (01/2016-09/2024). Patient’s demographics, stones characteristics and operative data were collected. Stone-free status was defined as no residual stones. Complications were graded according to modified Clavien classification. Descriptive statistics and logistic regression models were used to identify factors associated with postoperative infectious complications according to patient’s gender. Females accounted for 39.2% of the population and showed a significantly higher rate of postoperative infectious complications compared to males (24.9% vs. 16.7%, p = 0.02). Preoperative positive bladder urine cultures were more frequent in females (27.9% vs. 16.1%, p = 0.01), as were infected stones (32.6% vs. 17.4%, p = 0.001). When stratified by gender, in males, infections were significantly associated with preoperative positive urine culture (p < 0.001) and residual stone status (p = 0.02), in females, longer operative time (p = 0.01) and residual stones (p = 0.02) were the main predictors. ROC curve analysis confirmed sex-specific thresholds for infection risk: in females, a stone volume ≥3.9 cm³ and operative time ≥96 minutes; in males, a stone volume ≥5.1 cm³ and operative time ≥137 minutes. Female patients had higher risk of infections post PCNL than men. Surgical factors are associated with infections complications in female, while a combination of procedural and patient’s factors were found in men. In females, infectious complications occurred at lower stone volume and shorter operative time, suggesting that a gender-based risk strategy should be performed to prevent infections after PCNL.

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

Objectives: Restorative proctocolectomy and ileal pouch-anal anastomosis is frequently performed in patients with ulcerative colitis and factors suspected of increasing the risk of postoperative infectious complications. Using a three-stage approach may result in improvement in overall outcomes, because this leads to improvement in nutritional status and reduction of immunosuppressive doses. However, the influence of preoperative nutritional status on postoperative infectious complications after this procedure has not been examined. The aim of this study was to clarify the potential associations between nutritional status and postoperative infectious complications in patients with ulcerative colitis undergoing proctectomy with ileal pouch-anal anastomosis. Methods: The records of 110 patients who had undergone proctectomy with ileal pouch-anal anastomosis from January 2000 to March 2018 in Mie University and met the eligibility criteria were reviewed and possible associations between postoperative infectious complications and clinical factors were assessed. Results: Of the remaining 110 patients, 18 (16.4%) had developed postoperative infectious complications. Multivariate analysis revealed that operative bleeding ≥270 g and prognostic nutritional index <47 were significant predictors of postoperative infectious complications (P = 0.033, 0.0076, respectively). Various variables associated with immunosuppressives before ileal pouch-anal anastomosis were not associated with postoperative infectious complications. Conclusions: Our findings suggest that immunosuppressives have no association with postoperative infectious complications, whereas a poor prognostic nutritional index may be a significant predictor of postoperative infectious complications in patients with ulcerative colitis undergoing proctectomy with ileal pouch-anal anastomosis.

With the advent of percutaneous nephrolithotomy (PCNL), the use of traditional surgery for the treatment of staghorn kidney stones has become rarer. The objective of this study was to report the outcomes of percutaneous nephrolithotomy in the treatment of staghorn kidney stones. This is a retrospective longitudinal descriptive and analytical study. It included all patients treated for a staghorn stone who underwent PNL between January 2015 and December 2021. We included 44 patients. Six patients experienced intraoperative bleeding. We reported the occurrence of postoperative infectious complications in 15 patients. The stone-free rate was 42%. Predictive factors for residual fragments were complete staghorn stone (p=0.02) and large stone volume (p=0.001). Predictive factors for hemorrhagic complications were the use of anticoagulant therapy (p=0.01), renal cavity dilation (p=0.01), complete staghorn stone (p=0.02), and large stone mass (p0.001). Predictive factors for postoperative infectious complications were diabetes (p=0.048), positive preoperative urine culture (p=0.03), renal cavity dilation (p=0.04), complete staghorn stone (p=0.02), and postoperative drainage by ureteral stent (p-0.001). PCNL is a minimally invasive and effective technique when safety conditions are met, and it has become the standard in the treatment of staghorn stones. Kidney stones, Percutaneous nephrolithotomy, Staghorn stones.

BackgroundWe have previously demonstrated that blood transfusion (BT) was associated with post-operative complications in patients undergoing surgery for Crohn’s disease (CD), based on our institutional data registry. The aim of this study was to verify the association between perioperative BT and infectious complications in CD patients enrolled in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database.MethodsAll CD patients undergoing surgery between 2005 and 2013 were identified from NSQIP. Variables were defined according to the ACS NSQIP guidelines. The primary outcome was infectious complications, including superficial, deep and organ/space surgical site infection, wound dehiscence, urinary tract infection, pneumonia, systemic sepsis and septic shock. Multivariate analyses were performed to assess the risk factors for post-operative infections.ResultsAll 10 100 eligible patients were included and 611 (6.0%) received perioperative BT. BT patients were older, lighter in weight and more likely to be functionally dependent. BT patients were more likely to have post-operative infectious complications than those without BT, including superficial surgical site infection (SSI) (10.8% vs 7.4%, p=0.002), deep SSI (3.3% vs 1.6%, p=0.003), organ/space SSI (14.2% vs 5.4%, p<0.001), pneumonia (3.8% vs 1.3%, p<0.001), urinary tract infection (3.9% vs 2.2%, p=0.006), sepsis (11.5% vs 4.5%, p<0.001) and sepsis shock (3.1% vs 0.8%, p<0.001). Multivariate analysis showed that intra- and/or post-operative BT was an independent risk factor for post-operative infectious complications (odds ratio [OR] = 2.2; 95% confidence interval [CI]: 1.8–2.7; p<0.001) and the risk increased with each administered unit of red blood cell (OR = 1.3, 95% CI: 1.2–1.5). Other independent factors were history of smoking, chronic heart disease, diabetes, hypertension and the use of corticosteroids. Pre-operative BT, however, was not found to be a risk factor to post-operative infections.ConclusionsIntra- and/or post-operative, not pre-operative, BT was found to be associated with an increased risk for post-operative infectious complications in this CD cohort. Therefore, the timing and risks and benefits of BT should be carefully balanced.

Antibiotics are widely given for surgical patients to prevent infection. Because of the lack of study on the rational use of antibiotics in patients with human immunodeficiency virus (HIV) -infected during surgical procedures, we analyzed the risk factors affecting postoperative infectious complications in HlV-infected patients and explore the rational use of perioperative antibiotics. This retrospective study consisted of 308 HlV-infected patients, 272 males and 36 females, who had undergone operation at the Shanghai Public Health Clinical Center from November 2008 to April 2012. The patients were divided into postoperative infection and non-infection groups. Their age and clinical variables were compared. The correlation between surgical incision, surgical site infection (SSI) and postoperative sepsis was analyzed. Prophylactic antibiotics were used for patients with type I and II incisions for less than 2 days. Patients with type III incisions were given antibiotics until the infection was controlled. Antiretroviral therapy (ART) was prescribed preoperatively for patients whose preoperative CD4 count was <350 cells/μL. For those patients whose preoperative CD4 count was <200 cells/μL, sulfamethoxazole and fluconazole were given preoperatively as prophylactic agents controlling Pneumocystis carinii pneumonia and fungal infection. A total of 196 patients developed postoperative infectious complications, and 7 patients died. Preoperative CD4 counts, ratio of CD4/CD8 cells, hemoglobin level, and postoperative CD4 counts, hemoglobin and albumin levels were risk factors of perioperative infection in HIV-infected patients. Patients with a preoperative CD4 count <200 cell/μL, anemia, a postoperative CD4 count <200 cell/μL or albumin levels <35 g/L were correlated with a higher rate of perioperative infection. There was a significant correlation between SSI and the type of surgical incision. The rate of SSI in patients with type I surgical incision was 2% and in those with type II surgical incision was 38%. All the patients who received type III surgical incision developed SSI, and they were more likely to develop postoperative sepsis. HIV-infected patients are more likely to develop postoperative infectious complications. The rational use of antibiotics in HIV-infected patients could help to reduce the rate of postoperative infectious complications in these patients.

Objectives The aims of the study are to analyze the potential risk factors associated with systemic inflammatory response syndrome after percutaneous nephrolithotomy for renal stones and to establish a predictive model to prevent postoperative early urosepsis postoperative with percutaneous nephrolithotomy and develop a novel nomogram. Methods Patients who had undergone percutaneous nephrolithotomy between June 2012 and December 2019 were enrolled and classified into two groups according to their systemic inflammatory response status. Univariable and multivariable logistic regression analyses were performed to identify the predictive factors associated with systemic inflammatory response syndrome after percutaneous nephrolithotomy. The nomograms were developed by using the significant factors, and the discriminative ability was assessed using receiver operating characteristic curve analyses. Results Two hundred sixty two patients with renal stones treated with percutaneous nephrolithotomy were enrolled, and systemic inflammatory response syndrome occurred in 117 patients (44%) after percutaneous nephrolithotomy. Multivariable logistic regression analysis revealed that the three factors independently related to systemic inflammatory response syndrome: renal stone size ≥3 cm, positive preoperative urine white blood cells, and positive preoperative urine culture. According to the results, the logistic regression analyses of significant factors were used to develop the nomogram. Developed nomogram prediction model displayed favorable fitting in the Hosmer-Lemeshow test (P = 0.938). Internal validation of the nomogram showed that the area under the receiver operating characteristic curve was 0.702. Conclusions Positive preoperative urine white blood cells, positive urine culture, and renal stone size ≥3 cm are the most significant predictors. The novel nomogram helps identify high-risk individuals and facilitates the early detection of systemic inflammatory response syndrome after percutaneous nephrolithotomy.

To evaluate association between postoperative serum procalcitonin (PCT) levels and infectious complications following mini-percutaneous nephrolithotomy (mini-PCNL), and to identify predictors of elevated PCT. We retrospectively analyzed 496 adult patients who underwent mini-PCNL for kidney stones (February 2020-March 2025). Patients were stratified into four groups based on postoperative fever occurrence and PCT levels (≤ 2.0 ng/ml vs. > 2.0 ng/ml): Group 1 (no fever, low PCT, n = 404), Group 2 (fever, low PCT, n = 10), Group 3 (no fever, high PCT, n = 65), and Group 4 (fever, high PCT, n = 17). Multivariable logistic regression analysis identified factors associated with PCT levels > 2.0 ng/ml. Elevated PCT occurred in 82 patients (16.5%). Groups 3 and 4 had significantly higher rates of positive preoperative urine cultures (46.2% and 64.7%) compared to Groups 1 and 2 (6.2% and 30%, p < 0.001). Positive stone cultures were more frequent in Group 3 (50.8%). Median PCT level was higher in Group 4 [38.00 (13.10-87.70) ng/mL] compared with Group 3 [18.10 (8.60-54.0) ng/mL]. Major infectious complications (Clavien ≥ 3) occurred exclusively in Group 4, including one sepsis-related death. Multivariable analysis revealed that positive preoperative urine culture (OR 6.72 95% CI 3.20-14.14) and stone culture (OR 4.83 95% CI 2.34-9.81) were independent predictors of elevated PCT. Elevated PCT following mini-PCNL is associated with positive preoperative urine and stone cultures, regardless of fever presence. Several patients exhibit elevated PCT without clinical manifestation of infection, suggesting a subclinical infection. These findings support the integration of PCT for enhanced risk stratification and postoperative management following mini-PCNL.