Stone Culture Research Articles

The clinical role of bacteremia and bacterial spread into the irrigation fluid during percutaneous nephrolithotomy: a prospective study.

Backflow of pathogens and endotoxins from the renal pelvis to the bloodstream is one supposed mechanism for infectious complications development after endourological stones surgery. The aim of this study is detecting to prove bacterial spread into irrigation fluid and bloodstream during percutaneous nephrolithotomy (PCNL) and to correlate these findings with clinical and microbiological parameters and infectious complications (IC). Bladder urine culture (BUC) was retrieved before PCNL; during the procedure, 2 blood samples (BC) and an irrigation fluid sample during fragmentation (SFUC) were collected for culture. Stone culture (SC) was also obtained. Patients were evaluated post-operatively for IC. Sixty-one patients were prospectively included. IC occurred in 15 patients (24.6%). SFUC was positive in 7/61 (11.5%); BC in 10/61 (16.4%). Among patients with positive BC; BUC, SFUC and SC were positive in 9 (90%), 6 (60%), and 8 (80%) cases, respectively. Out of 10 patients with positive BC, 4 developed post-operative IC. Pre-operative renal impairment (p = 0.04), intraoperative-evaluated stone residual (p = 0.02), BUC (p = 0.004), and SC (p = 0.008) were associated with IC. No correlation was found between bacterial spread in the irrigation fluid and blood and IC. We proved that bacteria can be detected into the irrigation fluid and blood during PCNL. This transient bacteremia appears to be unrelated to IC development.

Evaluation of Ordering Practices, Microbial Yield, and Clinical Utility of Urinary Stone Cultures

Abstract Urinary stones are a global problem. While it has been established that microorganisms can be associated with urinary stone formation, data on best practices for microbial culture and clinical interpretation of microbial culture of urinary stone specimens are limited. Our objective was to investigate the microorganisms present in urinary stone cultures (usc) and companion urine cultures. We conducted a retrospective study at a tertiry hospital examining cultures submitted between October 2018 and October 2021. We collected data from electronic medical records of patients who had at least at least one usc performed. As part of routine clinical workup, all urinary stone specimens submitted for culture were ground using a disposable tissue grinder and inoculated on a tryptic soy agar with 5% sheep blood agar plate (BAP), a chocolate agar plate (CHOC), and a MacConkey agar plate (MAC), streaked for isolation and incubated in 5% CO2 at 35°C for up to three days. Urine cultures were performed using the Kiestra TLA system with 10 µL of inoculum onto each of a BAP and MAC, and plates were examined at 16 and 24 hours of incubation. For urine specimens submitted from a straight or “in and out” catheter, 10,000 CFU/mL was the threshold for workup. From clean-voided, midstream, ileostomy, nephrostomy, or indwelling/Foley catheter specimens, 100,000 CFU/mL was the threshold for workup. The final clinical significance of cultures is determined by evaluating the culture result in light of the patient’s clinical presentation. For usc and urine cultures, clinically insignificant growth was considered no growth or when no pathogens were recovered in culture. Urine cultures with more than 3 species over threshold were considered contaminated. A total of 1,049 usc were performed from 854 patients (55.3% female). The median patient age was 61 years (IQR 49-70). The most frequent microorganisms reported in usc cultures were Proteus mirabilis (N=98), Enterococcus faecalis (N=75), and Escherichia coli (N=73). No pathogen was identified from 57% of usc. 441 usc were performed in a context of urine culture (+/-2 days) in 336 (39.3%) patients. In addition, 138 patients (16.1%) had more than 1 usc, being the maximum as 11 usc performed in one patient. The most common urine/USC concordant result was no growth in 165 of 441 cultures (37.4%), followed by coagulase negative Staphylococcus. Cohen’s kappa obtained from usc and urine culture results was 0.45, which is not the minimum acceptable agreement. A pathogen was identified from usc in 43% of cases. Usc and urine cultures rarely resulted in concordant results, but the most common concordant result was no growth in culture. Additional studies are warranted to evaluate the impact of usc results on patient care, including antimicrobial use and correlation of microbes isolated with stone chemical composition.

A Short Overview of Recent Developments in the Application of Polymeric Materials for the Conservation of Stone Cultural Heritage Elements.

Stones are ones of the most ancient natural materials exploited by humans, with different uses, from tools to buildings, that have endured over time in better conditions than other objects belonging to cultural heritage. Given the importance of those silent witnesses of our past, as well as our duty to preserve all parts of cultural heritage for future generations, much effort was put into the development of materials for their consolidation, protection, self-cleaning, or restoration. Protection of ancient stone monuments and objects has gained the interest of researchers in the last decades in the field of conservation of cultural heritage. In this respect, the present paper aims to be a critical discussion regarding potential polymeric materials, which can be used in restorative and conservative approaches for stone materials of cultural heritage importance, against physical degradation phenomena. Recent advances in this area are presented, as well as the current bottle-necks and future development perspectives.

The antibiotic strategies during percutaneous nephrolithotomy in China revealed the gap between the reality and the urological guidelines

BackgroundCorrect perioperative antibiotic strategies are crucial to prevent postoperative infections during percutaneous nephrolithotomy (PCNL). We aimed to compare the realistic antibiotic strategies applied in China with current urological guidelines.MethodsBetween April and May 2020, urologists from China were invited to finish an online cross-sectional survey. The questionnaire was designed according to the current urological guidelines and literatures.Results3393 completed responses were received. 61.1% (2073/3393) respondents had urological experience of more than 10 years. 72.4% urologists chose multiple-dose antibiotics for patients with both negative urine culture (UC-) and negative urine microscopy (UM-) preoperatively. Respondents in central China (OR = 1.518; 95% CI 1.102–2.092; P = 0.011), east China (OR = 1.528; 95% CI 1.179–1.979; P = 0.001) and northeast China (OR = 1.904; 95% CI 1.298–2.792; P = 0.001) were more likely to prescribe multiple-dose antibiotic for UC-UM- patients. Notably, the respondents who finished PCNL exceeded 100 cases per year were in favor of single-dose administration (OR = 0.674; 95% CI 0.519–0.875; P = 0.003). There are only 8.3% urologists chose single-dose antibiotic for UC-UM+ patients, whereas 65.5% administered antibiotics for 1–3 days. Meanwhile, for UC+ patients, 59.0% of the urologists applied antibiotics shorter than 1 week, and only 26.3% of the urologists carried out routine re-examination of UC. Moreover, postoperative antibiotics were frequently prescribed for 3–6 days (1815; 53.5%). Finally, although 88.2% urologists considered stone culture important for management of postoperative antibiotics as the guideline recommended, only 18.5% performed it routinely.ConclusionsThe antibiotic strategies are different between current practice in China and the urological guidelines. The dissimilarities suggested that further studies should be conducted to investigate the reasons of the differences and standardize the application of antibiotics.

SEPSIS IN POST-PCNL PATIENTS; RISK FACTORS AND INFLUENCE OF STONE CULTURES.

Objective: Post-operative sepsis is a well known complication of various endourologic procedures especially PCNL and it is caused by stone fragmentation containing toxins and bacteria with subsequent toxaemia and bacteremia. The present study was to determine clinical role of stone culture in modifying treatment and assess the factors that may increase the risk to develop sepsis after PCNL . Methods: A total of 211 patients (119 males and 92 females) with a mean age of 38.2 years were enrolled in this study at our single centre tertiary care institute . Patients with preoperative positive urine culture and sensitivity were excluded . All patients received prophylactic 3rd generation cephalosporin intravenously at the time of anaesthesia induction. Stone culture was taken from all patients after puncturing the pelvicalyceal system and sent for culture and sensitivity. Patients were monitored closely in the postoperative period for the development of SIRS. Risk factors such as diabetes, age, degree of hydronephrosis, residual fragments, number of access points PCNL type (standard versus mini) and stone burden were evaluated for the association with SIRS. Results: Mean duration of the operations was 82.7 min (30 to 110 min. ). 19 patients(9.0 %) developed post PCNL SIRS Stone culture identied organisms in8 patients(42% of patient cohort ). Treatment plan was changed as per antibiotic culture sensitivity in only one patientwith culture sensitivity report in three patients being multi drug resistant and rest responded to antibiotics they were receiving already. Statistically signicant factors for post PCNL fever were diabetes mellitus (DM) (p = 0.001), stone burden (p = 0.004), and degree of hydronephrosis (p = 0.04). Conclusion: Doing intraoperative stone cultures sensitivity does not confer additional benet for antibiotic change in majority of cases.DM, staghorn stones, degree of hydronephrosis, duration of the operation and number of tracts are risk factors for post PCNL SIRS.

Investigation of Virulence Genes of the Predominant Bacteria Associated with Renal Stones and their Correlation with Postoperative Septic Complications.

PurposeNephrolithiasis is a worldwide disease, and 4.7% of the patients may develop postoperative sepsis. Characterization of virulence genes of bacteria associated with renal stones is still lacking in the literature. The study aimed to investigate the virulence genes of the predominant stone bacterial isolate and their association with postoperative septic complications in patients treated with percutaneous nephrolithotomy (PCNL).MethodsStone and midstream urine samples were collected from 200 nephrolithiasis patients who underwent PCNL. Microbiological examination and virulence profile were studied for the common bacteria isolated from the stones.ResultsMicrobiological analysis revealed that Staphylococcus aureus was the predominant organism in stone samples (42.8%), while Escherichia coli (56.6%) was the dominant pathogen in midstream urine. Eight patients (4%) developed septic complications; stone culture was positive for S. aureus in seven and E. coli in one patient, while all but one had negative midstream urine. The patient with positive midstream urine culture had also S. aureus infection. Detection of virulence genes in S. aureus isolated from stones showed a high positivity of the hemolysine gene hla (93.3%) and adhesion gene fnbA (73.3%), whereas enterotoxin genes (sec and sea) were negative in all S. aureus stone cultures. Moreover, the adhesion genes (fnbB and can), hemolysine gene (hlb), panton-valentine leukocidin (pvl) gene and the enterotoxin gene (seb) were significantly higher in septic patients compared to the non-septic ones (p< 0.05). Interestingly, there was a significant relation between the existence of virulence genes and the resistance of antibiotics (p < 0.05).ConclusionThere has been a notable shift toward gram-positive organisms (S. aureus) in the stone culture. Moreover, S. aureus virulence genes were significantly attributed to the resistance of some antibiotics and postoperative septic complications, suggesting that the stone culture could be more informative than urine culture, especially in predicting the risk of postoperative sepsis.

Biochemical characteristics of introduced cherry varieties in the Astrakhan region

Cherry is a widespread stone culture, cherry fruits are saturated with nutrients with a rel-atively low caloric content. The article presents and summarizes the data of biochemical studies on the nutrient content of 6 varieties of cherries of domestic selection. The studies were carried out for two years (2020–2021). The plantings were planted according to the generally accepted scheme of 3?5 m. The biochemical composition of cherry fruits was studied (the content of soluble solids, titrated acids, the sum of sugars, ascorbic acid). A sugar-acid index was calculated for each variety. According to the results of the conducted studies, the best varieties were identified according to the biochemical composition of cherry fruits: in terms of the content of dry soluble substances - above 18 % in Dubovochka (control), Lubskaya, Turgenevskaya and Molodezhnaya varieties; low acidity (0.8–1.2) in Loznovskaya, Molozhnaya and Dubovochka varieties (control); in terms of sugar content – Lubovskaya, Turgenevskaya, Miracle cherry and Molodezhnaya (the sum of sugars is more than 10 %). The sugar-acid index of cherry fruits ranges from 5.2–12.1, the content of ascorbic acid is above 16 %. The analysis of the data obtained made it possible to identify cherry varieties Loznovskaya and Molodezhnaya, which have a complex of valuable biochemical indicators of interest for further study, performance of breeding tasks and improvement of the assortment in the conditions of the Astrakhan region.

Facile Two-Step Deposition of Calcium Oxalate Film on Dolomite to Improve Acid Rain Resistance

The deposition of a calcium oxalate layer on dolomite demonstrates potential application in stone culture heritage conservation. However, due to insufficient coverage and the presence of cracks, the film’s usefulness is restricted. In this investigation, we used a simple two-step procedure to create a cohesive and uncracked film. The findings show that the protective layer provides better coverage of the dolomite surface without causing cracks and significantly improves acid resistance. Furthermore, after the simple two-step treatment, the color and adhesive strength of dolomite substrates remained nearly unchanged.

MP44-13 STONE CULTURES FOR URETEROSCOPY: ARE THEY NECESSARY AND WHO NEEDS THEM? RESULTS FROM A SINGLE INSTITUTION SERIES

You have accessJournal of UrologyCME1 May 2022MP44-13 STONE CULTURES FOR URETEROSCOPY: ARE THEY NECESSARY AND WHO NEEDS THEM? RESULTS FROM A SINGLE INSTITUTION SERIES Daniel Wong, Kenneth Sands, and Alana Desai Daniel WongDaniel Wong More articles by this author , Kenneth SandsKenneth Sands More articles by this author , and Alana DesaiAlana Desai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002610.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Stone cultures are recommended for high risk PCNL however their utility during ureteroscopy is less understood. We evaluate stone culture as a factor for post ureteroscopy infectious complications and determine which characteristics are associated with positive stone culture to better guide management. METHODS: Using an institutional database of stone extraction cases from 2016-2020, we evaluate all ureteroscopy cases in which stone culture was sent. We perform univariate analysis to identify factors associated with postop infection as defined by T>38°C, WBC >12K or <4K, HR >90, or UTI within 30 days of procedure. Logistic regression was performed on variables historically associated with postop infection. Univariate analysis was performed to determine factors associated with positive stone culture, followed by logistic regression using statistically significant variables. RESULTS: Of 274 ureteroscopy cases where stone culture was obtained, 71(25%) had a positive stone culture and 33(12%) had a postop infection.(Figure 1) Female sex and positive stone culture were associated with post-op infection. Positive stone culture remained the only significant predictor of postop infection on logistic regression. Predictors of positive stone culture were higher Charleston Comorbidity Index(CCI), operative time, history of UTI, and neurogenic bladder. (Figure 2) In the 33 cases of postop infection, 21 had organisms identified on post-op urine or blood cultures. Preop urine culture and stone culture were congruent with postop culture in 5(23%) and 8(38%) cases respectively. Of 12 cases with no postop organism identified, stone culture was positive in 4(33%) and preop culture was positive in 0. CONCLUSIONS: Stone culture is predictive of postop infection after ureteroscopy. Urologists should prioritize sending stone cultures for high risk patients such as those with neurogenic bladder. Stone culture may provide the only chance at culture directed antibiotic therapy in a portion of cases. Source of Funding: Washington University School of Medicine © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e757 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Wong More articles by this author Kenneth Sands More articles by this author Alana Desai More articles by this author Expand All Advertisement PDF DownloadLoading ...

Study on Monitoring Methods of Stone Cultural Relics - Taking Shaoxing Yangshan Statue as an Example

In recent years, due to the structural factors of the rock mass itself, many rock masses are in an unstable state, and there are many structural fissures in the rock mass.There is a serious seepage phenomenon inside the cave, and the weathering diseases on the surface of the rock mass have appeared to varying degrees. Its cultural, artistic and scientific values need to be continued. Through modern instrument and scientific testing scheme, the horizontal displacement, crack and stress of reinforced anchor cable of dangerous rock mass are monitored in real time. After material reinforcement and repair, continuous monitoring is carried out to check the repair effect and ensure that the repair scheme is effective. Keywords : unstability; crack; weathering; monitoring DOI: 10.7176/CER/14-2-04 Publication date: April 30 th 2022

Biocides for the Control of Mosses on Stone Cultural Relics

ABSTRACT Controlling biodeterioration is a worldwide necessity for the preservation of cultural heritage. Biocides are the most effective compounds used for heritage protection of stone; however, their specific efficacy, performance over time, interference with cultural heritage materials, and potential hazards are still unclear. In this work, we test and evaluate a large number of biocides to address the degradation of stone cultural relics by mosses. The quantitative and qualitative evaluations of biocide efficiency were performed by chlorophyll fluorescence (ChlaF) measurements and confocal microscopy. Surprisingly, traditional herbicides (glyphosate, glufosinate-ammonium) and metal oxide nanoparticles (CuO, ZnO) with antibacterial effects do not affect mosses. However, some plant hormones and essential oils showed good effects at all stages of moss growth. Meanwhile, biocides were also tested on artificial simulated rocks to see if they change their properties. It turns out that biocides containing copper ions can cause chromaticity changes on the rock surfaces. In the end, a total of six efficient and safe biocides were obtained, which will play a good role in biological control for cultural heritage protection.

Predictive accuracy of the modified SOFA score, SIRS criteria, and qSOFA score for uroseptic shock after mini-percutaneous nephrolithotomy.

The purpose of this study was to determine the plausibility and utility of utilizing a modified SOFA (mSOFA) score for predicting urosepticshock after mini-percutaneous nephrolithotomy. A cohort of 707 patients who received mini-PCNL from August 2019 to December 2020 was retrospectively evaluated. The area under receiver operating characteristic curve (AUROC) was used to compare the predictive value of septic shock between mSOFA, systemic inflammatory response syndrome (SIRS) and qSOFA. Among 707 patients, 24 patients experienced uroseptic shock after mini-PCNL. Compared with the no uroseptic shock group, the proportion of females and rates of preoperative urine culture, renal pelvis urine culture and stone culture positivity were higher in the uroseptic shock group, with high levels of preoperative C-reactive protein (CRP) and postoperative procalcitonin (PCT). In the uroseptic shock group, the mSOFA score increased by two or more points in 83.3%; 79.2% had at least two SIRS criteria, and 100% had a qSOFA score of at least one point. mSOFA score (AUROC = 0.866, 95% CI: 0.779-0.954) exhibited greater discrimination for uroseptic shock after PCNL than SIRS (AUROC = 0.838, 95% CI: 0.742-0.943) and qSOFA (AUROC = 0.851, 95% CI: 0.811-0.892). In conclusion, the predictive value of the modified SOFA score for uroseptic shock after mini-PCNL was greater than that of the qSOFA score or SIRS.

A pXRF-Based Approach to Identifying the Material Source of Stone Cultural Relics: A Case Study

Precise identification of material sources is of great significance to archaeological study, conservation, and restoration of stone cultural relics. The present study proposes a simple and efficient approach to identifying the material source of stone cultural relics based on portable X-ray fluorescence spectrometer (pXRF) and statistical analyses. Chemical elements of stone samples, including Ca, K, Fe, Al, Si, Cl, S, and Mg from both cultural relics and potential quarries, were first measured non-destructively using a pXRF device. Obtained chemical element data were then classified using statistical techniques (i.e., cluster analysis and principal component analysis) to match tested materials from cultural relics to the material from a quarry, thereby identifying the material source of stone cultural relics. The proposed method was applied to identify the material sources of the Jin Gang Throne Tower (JGT Tower), the stele of “Rebuilding Pu’ansi Temple” (PAS Stele), and the stele of “Renovation of Sanjinmiao Temple” (SJM Stele) in Beijing Stone Carving Art Museum. The study shows that pXRF can be used on-site for handheld, fast, inexpensive, and non-destructive measurements of the elemental composition of stone materials, being a powerful tool for identifying the material source of stone culture relics especially immovable and large-scale ones.

Jeju Stone Cultural Landscape which Contains Stories about People who Continue to Have Relationships with Stones, Whether Alive or Dead

Jeju Stone Cultural Landscape which Contains Stories about People who Continue to Have Relationships with Stones, Whether Alive or Dead

Do Infection-Associated Stone Subtypes Behave the Same Clinically? A Retrospective Bicenter Study.

Introduction and Objectives: Infection-associated renal stones are commonly composed of magnesium-ammonium-phosphate (MAP) and carbonate apatite (CA). The clinical implications of these two different, but closely related stone types, are unknown. We sought to compare the clinical, microbiologic, and metabolic characteristics of patients with MAP and CA stone types. Methods: We retrospectively reviewed the medical records of patients from two centers (one in the United States and one in Israel) who underwent ureteroscopy or percutaneous nephrolithotomy between 2012 and 2020 and identified patients with a predominant stone analysis component of CA or MAP and clinical data supporting an infection stone. We analyzed and compared demographic data, medical history, postoperative fever, stone and urinary microbiology, and 24-hour urine studies. Results: A total of 79 and 75 patients met the inclusion criteria for the MAP and CA cohorts, respectively. No significant difference was found in patient demographics or comorbidities between the MAP and CA cohort. Female predominance was noted in both. Although there were no significant differences in 24-hour urine parameters between the cohorts, hypercalciuria was common in both cohorts (38% and 32% of patients in the MAP and CA cohorts, respectively). Gram-negative bacteria were more common in the MAP stone cultures. Postoperative fever was significantly more common in the MAP cohort (14.7% vs 3.8%, p < 0.016). Conclusions: MAP and CA stone formers share similar demographic characteristics with a clear female predominance. MAP stones patients appear more likely to develop postoperative fever, possibly related to a higher occurrence of gram-negative bacteria in the stone cultures of the MAP cohort. Although there were no significant differences among metabolic parameters, hypercalciuria was noted in approximately a third of the cohort. The clinical significance of this finding is yet to be determined.

Comparison of Perioperative Outcomes and Clinical Characteristics of Calcium, Matrix and Struvite Stones From a Single Institution

ObjectiveTo define risk factors and perioperative outcomes for matrix stones and compare these outcomes with struvite and calcium stone cohorts. MethodsA retrospective cohort study comparing matrix stones (n=32), struvite stones (n=23) and a matched, calcium stone control group (n=32) was performed. Two-way ANOVA was used to compare the groups for continuous variables. Chi-square tests were used to compare categorical variables. Significance was set at P <.05. All statistical tests were performed using R (v1.73). ResultsWe identified no differences in age, gender, or BMI between the three groups. Matrix and struvite stones were more likely to have a history of prior stone surgery and recurrent UTIs compared to calcium stones (P=.027 and P <.001, respectively). Struvite stones were more likely to present as staghorn calculi compared to matrix or calcium stones (56.5% vs 21.7% vs 18.8%, P=.006). There were no significant differences in postoperative stone free rates (P=.378). No significant differences in postoperative infectious complications were identified. Matrix stones were more likely to have Candida on stone culture compared to the struvite or calcium stones (P <.0001). ConclusionMatrix and struvite stones were more likely have a history of stone surgery and preoperative recurrent UTIs. Struvite stones were more likely to present as staghorn calculi. Matrix stones were more likely to have Candida present in stone cultures. However, no difference in postoperative infectious outcomes or stone free rates were identified. Further study with larger cohorts is necessary to distinguish matrix stone postoperative outcomes from struvite and calcium stones.

Gas-containing renal stones: a red flag for renal infection.

Gas in the renal excretory system is described as a consequence of recent procedures but it can be a sign of severe conditions such as fistulas or infections; however, gas-containing renal stones are only rarely encountered. To describe the association of gas-containing renal stones and urinary tract infection. We performed a retrospective evaluation of the clinical and imaging findings in a series of six patients with gas-containing renal stones and compared our findings with those of patients with gas-containing renal stones reported in the literature. Urine and stone cultures were used as a diagnostic standard for urinary tract infection. Including the present series, there is a total of 21 patients with gas-containing renal stones in the literature. Based on clinical presentation, urinary tract infection could be suspected in 10 (57%) patients, while urine and/or stone cultures showed infection in 18 of 19 (95%) patients, with only one case with no bacterial growth in both (5%); in the remaining patient the information was not available. Gas-containing renal stones are a rarely reported entity usually diagnosed with computed tomography. They are a radiological sign often associated with urinary tract infection that can also be encountered in patients with non-specific renal symptoms.

Preoperative antibiotic therapy exceeding 7days can minimize infectious complications after percutaneous nephrolithotomy in patients with positive urine culture.

To explore an appropriate duration of antibiotic therapy before percutaneous nephrolithotomy (PCNL) in patients with positive urine culture. From March 2016 to May 2018, consecutive patients with positive urine culture undergoing PCNL were prospectively registered. Initial preoperative antibiotics were given empirically. If needed, antibiotics were upgraded or adjusted to susceptible antibiotic after obtaining antibiotic-sensitivity test. Postoperative systemic inflammatory response syndrome (SIRS) was the primary outcome. Among the 220 participants, the incidence of positive stone culture and SIRS were 85.5% and 36.8%. Escherichia coli (53.6%, 44.5%) and Proteus mirabilis (8.2%, 10.0%) were the top two bacteria in urine and stones. In univariable analysis, patients with postoperative SIRS had a higher rate of stone culture positivity (97.5% VS 78.4%, P < 0.001) and a shorter duration of preoperative antibiotics therapy (3.4 ± 2.7days versus 4.2 ± 2.8days, P = 0.037). The landscape of SIRS showed a declining trend as the elongation of preoperative antibiotics (P = 0.039). In a day-by-day comparison, SIRS was less prevalent in patients treated by pre-PCNL antibiotics ≥ 7days than in those with antibiotics ≤ 6days (21.7% VS 40.8%, P = 0.017). Multivariable logistic regression confirmed positive stone culture (P = 0.001, OR 11.115) as an independent risk factor and pre-PCNL antibiotics ≥ 7days (P = 0.048, OR 0.449) as an independent protective factor for SIRS. Preoperative antibiotic ≥ 7days decreased SIRS from 45.4 to 27.8% and from 9.1 to 0% in patients with a positive and negative stone culture, respectively. Exceeding seven days should be appropriate duration of antibiotic therapy before PCNL in patients with positive urine cultures.

MP06-14 USE OF STONE CULTURE ANTIBIOGRAM AND PERI-OPERATIVE RISK FACTORS TO PREDICT SEPSIS FOLLOWING PCNL

INTRODUCTION AND OBJECTIVE:Risk of sepsis after PCNL is highly correlated with stone culture results. High discordance between bladder urine culture and kidney stone culture calls into question the...

Preoperative Midstream Urine Cultures vs Renal Pelvic Urine Culture or Stone Culture in Predicting Systemic Inflammatory Response Syndrome and Urosepsis After Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis.

Purpose: To compare preoperative midstream urine cultures (PMUC) and renal pelvic urine culture (RPUC) or stone culture (SC) in predicting systemic inflammatory response syndrome (SIRS) and urosepsis after percutaneous nephrolithotomy (PCNL). Methods: We searched the PubMed, Web of Science, and EMBASE databases up to September 1, 2020, for relevant published studies. Two authors independently confirmed whether the literatures met the inclusion criteria and collected the data from the selected literatures. A meta-analysis was performed with Review Manager Software 5.4.1. A total of 14 studies with 3540 patients were selected and analyzed in the meta-analysis. Results: Pooled data showed that SC was associated with a higher sensitivity (odds ratios [OR] 2.36, confidence interval [95% CI] 1.31-4.25; p < 0.00001), positive predictive value (PPV) (OR 1.54, 95% CI 1.18-2.01; p = 0.16) and negative predictive values (OR 1.17, 95% CI 1.01-1.37; p = 0.06) in the diagnosis of SIRS and urosepsis after PCNL, and RPUC provided a significantly higher specificity (OR 2.70, 95% CI 2.16-3.38; p = 0.07) and PPV (OR 2.17, 95% CI 1.49-3.15; p = 0.48) than PMUC in the diagnosis of SIRS and urosepsis after PCNL. Conclusion: Intraoperative SC and RPUC are more reliable than PMUC in predicting postoperative SIRS and urosepsis, identifying causative organisms, and directing antibiotic therapy for patients who underwent PCNL. PMUC, SC, and RPUC should be routinely collected for the diagnosis and management of SIRS and urosepsis after PCNL.