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

Abstract

You have accessJournal of UrologyStone Disease: Evaluation I1 Apr 2014PD28-01 DOES PRE-OPERATIVE MULTI-DRUG RESISTANT URINE CULTURE PREDICT INFECTIOUS COMPLICATIONS AFTER PERCUTANEOUS NEPHROLITHOTOMY? Nishant Patel, MD Omer Raheem, MD Michael Liss, MD David Wenzler, MD William Shi, Craig Schallhorn, BS Charles Lakin, MD Michelle Ritter, andMD Roger L. SurMD Nishant PatelNishant Patel More articles by this author , Omer RaheemOmer Raheem More articles by this author , Michael LissMichael Liss More articles by this author , David WenzlerDavid Wenzler More articles by this author , William ShiWilliam Shi More articles by this author , Craig SchallhornCraig Schallhorn More articles by this author , Charles LakinCharles Lakin More articles by this author , Michelle RitterMichelle Ritter More articles by this author , and Roger L. SurRoger L. Sur More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2112AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES American Urological Association (AUA) Best Practice guidelines are in place to minimize infectious complications from percutaneous nephrolithotomy (PCNL). Multidrug resistant (MDR) uropathogens are increasing in prevalence and may contribute to significant morbidity following PCNL. We sought to document the prevalence of MDR baceteruria in patients whom underwent PCNL at our institution and evaluate whether presence of MDR bacteruria predicts for post-operative infectious complications. METHODS A retrospective review was performed of 83 patients undergoing PNCL by a single surgeon (RLS) between 2009-2013. Patient demographics, comorbidities, stone parameters on imaging, and microbial data was compiled. MDR organisms were defined as resistance to three or more of the AUA Best Practice Statement antimicrobial classes for PCNL (cephalosporin, aminoglycoside, fluoroquinolone, penicillin, clindamycin). Complications, Clavien score, and presence of post-operative infectious complications (EUA infection grade) were recorded. Univariate comparisons were analyzed between patients with and without a post-operative infectious complication. Multivariate logistic regression was performed to determine predicting variables for post-operative infectious complications. RESULTS Of the 83 patients undergoing PCNL, 49% had positive preoperative urine culture and 29% had positive MDR urine culture. Patients who had a post-operative infectious complication compared to those that did not, had an increased prevalence of staghorn calculus (50% vs. 18.6%, p=0.006) and an increased prevalence of pre-operative MDR urine culture (50% vs 20.3%, p=0.015). Controlling for age, stone size, and presence of renal structure abnormalities, multivariate analysis revealed presence of staghorn calculus increased the risk of a post-operative infectious complications by 4.15 times (95% CI 1.39-12.44, p=0.011). A positive pre-operative MDR urine culture increased the risk of post-operative infectious complication by 3.65 times (95% CI 1.23-10.87, p=0.02) despite appropriate culture-specific antibiotics. CONCLUSIONS Our institution demonstrated a relatively high prevalence of multi-drug resistant bacteruria in patients undergoing PCNL. The presence of a staghorn calculus and positive MDR urine culture predicted for a post-operative infectious complication. The higher risk of complications should be provided to patients undergoing PCNL and warrant extra attention to post-operative care by urologists. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e769 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Nishant Patel More articles by this author Omer Raheem More articles by this author Michael Liss More articles by this author David Wenzler More articles by this author William Shi More articles by this author Craig Schallhorn More articles by this author Charles Lakin More articles by this author Michelle Ritter More articles by this author Roger L. Sur More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...