The effect of delayed percutaneous nephrolithotomy on the risk of bacteremia and sepsis in patients with neuromuscular disorders

Abstract

To determine whether a delayed percutaneous nephrolithotomy (PCNL) reduces the rate of bacteremia/sepsis in patients with neuromuscular disorders. Patients with neuromuscular disorders are at higher risk of developing complications after PCNL. One strategy to reduce the risk of infectious complications is to place a percutaneous nephrostomy tube at least 24 h prior to performing PCNL. We analyzed the rates of bacteremia/sepsis in patients with neuromuscular disorders who had access on the day of PCNL (same-day) versus more than 24 h prior to the treatment for the stone (delayed). We identified 246 consecutive patients who underwent PCNL at our institution between 8/2003 and 8/2008, 35 of whom (14%) had neuromuscular disorders. The primary end point was postoperative bacteremia (fever and positive blood culture) or sepsis (SIRS and documented infection), which was compared between those who had percutaneous access on the day of surgery versus those who had access at least 24 h prior to the operative event. All patients had negative urine cultures preoperatively or were treated with antibiotics for 4-7 days prior to the surgery for a positive preoperative urine culture. The neuromuscular disorders in the 35 patients were multiple sclerosis (16), spina bifida (10), quadriplegia (4), paraplegia/Guillain-Barre (3), and cerebral palsy (2). The rate of bacteremia/sepsis among patients with neuromuscular disorders was 14%. The rate of sepsis/bacteremia was 26% for same-day PCNL versus 0% for delayed PCNL (OR 8.4, p = 0.05). Delayed PCNL results in lower rates of bacteremia and/or sepsis in patients with neuromuscular disorders.