Negative Preoperative Urine Culture Research Articles

Safety of Omitting Preoperative Antibiotic Prophylaxis in Patients Undergoing Transurethral Ureterolithotripsy

Background: Transurethral ureterolithotripsy (TUL) is a common and highly efficient procedure for treating ureteral stones. The need for preoperative antibiotic prophylaxis to prevent post-TUL infections remains controversial. Objectives: This study aimed to investigate whether the removal of preoperative antibiotic prophylaxis affects the rate of postoperative complications in patients undergoing TUL. Methods: A total of 62 patients (aged 15-65 years) undergoing TUL between November 2021 and March 2022 were included in this controlled clinical trial. Patients were divided into two groups by the available gradual and sequential sampling methods: 33 had positive preoperative urine culture (UC), and 29 had negative preoperative UC. None of the patients in the two groups received preoperative antibiotic prophylaxis. Perioperative and postoperative outcomes, such as the operative time, stone-free rate, postoperative analgesic use, fever, urinary tract infection (UTI), and hospital stay, were reviewed in both groups. Results: Patients with positive UC were significantly older than those with negative UC (P=0.018), and had a higher BMI (P=0.016). No significant differences were observed between the two groups in most perioperative variables or postoperative outcomes (P>0.05). In addition, patients in the positive UC group had significantly more underlying diseases than the other group (P=0.022). Postoperative symptomatic UTI was found in neither of the two groups. Fever was reported in 3 (9.1%) and 1 (3.4%) patients in the positive and negative UC groups, respectively, with no statistically significant differences between the two groups (P=0.616). In the matched logistic regression model, the effect of preoperative UC on postoperative fever was not significant (P=0.40). Conclusion: The results of our study showed that prophylactic antibiotics can be eliminated at the discretion of the surgeon in patients without symptomatic positive UC.

MP34-16 RANDOMIZED PHASE II STUDY OF ANTIBIOTIC PROPHYLAXIS WITH ORAL 3 GR FOSFOMYCIN TROMETHAMINE VS PREOPERATIVE AMIKACIN 1 GR I.V. IN PATIENTS UNDERGOING TRANSURETHRAL RESECTION OF THE BLADDER

You have accessJournal of UrologyCME1 Apr 2023MP34-16 RANDOMIZED PHASE II STUDY OF ANTIBIOTIC PROPHYLAXIS WITH ORAL 3 GR FOSFOMYCIN TROMETHAMINE VS PREOPERATIVE AMIKACIN 1 GR I.V. IN PATIENTS UNDERGOING TRANSURETHRAL RESECTION OF THE BLADDER Adrian Garza-Gangemi, David Gomez-Ortiz, Guillermo Martinez-Delgado, Renata Duarte-Valdes, Ricardo Tinoco-Betancourt, Francisco Rodriguez-Covarrubias, and Ricardo Castillejos-Molina Adrian Garza-GangemiAdrian Garza-Gangemi More articles by this author , David Gomez-OrtizDavid Gomez-Ortiz More articles by this author , Guillermo Martinez-DelgadoGuillermo Martinez-Delgado More articles by this author , Renata Duarte-ValdesRenata Duarte-Valdes More articles by this author , Ricardo Tinoco-BetancourtRicardo Tinoco-Betancourt More articles by this author , Francisco Rodriguez-CovarrubiasFrancisco Rodriguez-Covarrubias More articles by this author , and Ricardo Castillejos-MolinaRicardo Castillejos-Molina More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003268.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary tract infections are one of the most common complications following transurethral resection of the bladder (TURBT). Antibiotic prophylaxis is indicated in every patient, however recommendations are essentially empiric and based on older studies. An adequate prophylaxis should be tailored on local microbiological data to minimize postoperative infectious complications. The aim of this study was to compare preoperative oral 3 gr Fosfomycin tromethamine vs intravenous 1 gr amikacin administration in patients undergoing TURBT. METHODS: Between January 2020 and November 2022, a double blind, phase II randomized clinical trial was conducted in a tertiary center in Mexico City. Patients undergoing TURBT were randomly assigned to two groups; oral Fosfomycin Tromethamine 3 gr (one day before) vs. preoperative amikacin 1 gr I.V. (control group). The primary endpoints were the development of urinary tract infection (UTI), asymptomatic bacteriuria (AB) and sepsis 30 days after surgical resection. Every patient had a negative preoperative urine culture, absence of urinary symptoms, no use of antibiotics 15 days prior to surgery and no indwelling catheters. Baseline and perioperative characteristics were compared between study groups. Relative risk and independent risk factors for the development of UTI and/or AB were calculated. Every patient had a postoperative midstream urine culture 1 month after surgical resection. This study was IRB approved and was registered in ClinicalTrials.gov, NCT 04209192. RESULTS: Seventy five patients were included in the study and 71 completed follow up (control group n=37) and were further analyzed. There were no significant differences in baseline characteristics between study groups (age, sex, comorbidities, smoking status, ECOG score, ASA score) and no differences in perioperative characteristics (surgical time, number of tumors, tumor size, bleeding, and postoperative catheter duration). There were no differences in postoperative UTI (11.8% vs 5.4% in control group, p=0.42) and AB (2.9% vs. 8.1% in control group, p=0.62) between study groups. No patient developed postoperative sepsis. No adverse effects related to antibiotic use were reported in this study. CONCLUSIONS: There were no significant differences in the development of infectious complications following TURBT between study groups. Oral 3 gr Fosfomycin tromethamine may be a reasonable alternative for prophylaxis in these patients. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e465 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Adrian Garza-Gangemi More articles by this author David Gomez-Ortiz More articles by this author Guillermo Martinez-Delgado More articles by this author Renata Duarte-Valdes More articles by this author Ricardo Tinoco-Betancourt More articles by this author Francisco Rodriguez-Covarrubias More articles by this author Ricardo Castillejos-Molina More articles by this author Expand All Advertisement PDF downloadLoading ...

Nomogram for predicting risk factors of fever in patients with negative preoperative urine culture after retrograde intrarenal surgery.

To determine the risk factors for postoperative fever after retrograde intrarenal surgery (RIRS) in patients with negative preoperative urine culture (UC), and to establish a nomogram for predicting postoperative fever based on these risk factors. This study collected 322 patients with negative UC who received RIRS at the First Affiliated Hospital of Anhui Medical University from March 2019 to May 2022. The study population was divided into a fever group and a non-fever group. The risk factors of postoperative fever were determined by univariate and multivariate logistic regression analyses, and a nomogram was established. The nomogram was evaluated in terms of differentiation, calibration, and clinical practicability. In this study, 47 (14.6%) patients developed a fever after surgery. Multivariate logistic regression analysis showed that for patients with negative preoperative urine culture, urinary leucocyte esterase (P = 0.005), operative time (P = 0.019), and intraoperative hypotension (P = 0.028) were independent risk factors of postoperative fever, and a nomogram was constructed according to the above variables. The area under the curve (AUC) calculated by receiver operating characteristic (ROC) analysis was 0.807 (95% CI 0.739-0.876), indicating good discrimination. The calibration curves showed good consistency, and the clinical decision curve analysis (DCA) showed the clinical applicability of the model. For patients with negative preoperative urine culture, urine leukocyte esterase, operative time, and intraoperative hypotension are independent risk factors of postoperative fever. The new nomogram can better assess the risk of infection in patients with negative UC after RIRS.

A nomogram for predicting postoperative urosepsis following retrograde intrarenal surgery in upper urinary calculi patients with negative preoperative urine culture

Retrograde intrarenal surgery (RIRS) is one of the main surgical methods for upper urinary calculi, but severe complications of infection may occur after surgery. This study aimed to establish and validate a preoperative nomogram for predicting postoperative urosepsis following retrograde intrarenal surgery to treat upper urinary calculus in patients with a negative preoperative urine culture. We retrospectively recruited 1767 patients with negative preoperative urine cultures who underwent retrograde intrarenal surgery to treat upper urinary calculi from January 2017 to April 2022. The independent risk factors for urosepsis include a solitary kidney, positive urine nitrite, operative time ≥ 75 min, history of recurrent urinary tract infections, and history of diabetes were identified by univariate analysis and multivariate binary logistic regression analysis, which construct a nomogram. The receiver operating characteristic curve of the nomogram for predicting urosepsis was 0.887 in the training cohort and 0.864 in the validation cohort, respectively. The calibration curve and decision curve analysis demonstrated great consistency and clinical utility of the nomogram. Therefore, the nomogram combining preoperative independent risk factors can predict the probability of a postoperative urosepsis following retrograde intrarenal surgery in patients with a negative preoperative urine culture, which could help urologists take preventive measures in advance after surgery to avoid more serious complications of infection.

Comparative Study between Initial Positive and Negative Preoperative Urine Culture for Postoperative Fever in PCNL Patients

Background: The exact mechanism of fever after PCNL has not been established.2. This research studied the frequency of post-PCNL fever and UTI in both initial preoperative positive and negative urine culture group of patients. Objectives: To compare the frequency of post PCNL fever and UTI in initial positive and negative preoperative urine culture patients. Method: This was a prospective observational study on a total sixty patients who underwent single PCNL at the Department of Urology, Sir Salimullah Medical College Mitford Hospital, Dhaka and National Institute of Kidney Diseases and Urology, Dhaka from March 2013 to October 2014.There were two groups of patients, Group-I, with initial positive preoperative urine culture and another Group-II with initial negative preoperative urine culture. But the operation deferred until the positive urine culture became negative. Both groups received prophylactic antibiotic. Results: The frequency of fever and UTI after PCNL was 53.33% in Group-I (n=30) but only 23.33% was found in Group-II (n=30).Significant correlations were observed between post-PCNL fever with initial positive preoperative urine culture group (p=0.017), female sex (p=0.02), prolong hospital stay (p=0.018). Conclusion: The frequency of postoperative fever and UTI is more than two times in preoperative positive urine culture patients than culture negative patients. Risk of post- PCNL fever increased in patients who had initial positive preoperative urine culture. Bangladesh J. Urol. 2021; 24(1): 25-32

Impact of eliminating urethral catheterization following ureterorenoscopic lithotripsy.

To show that elimination of a urethral catheter in ureterorenoscopic lithotripsy cases is not disadvantageous. We reviewed 164 non-catheterized patients (experimental group) and 656 catheterized patients (control group) with renal or ureteral stones treated at our institution. Inclusion criteria were initial operation, patient age 18 to 75 years, no dysuria, and no preoperative febrile urinary tract infection due to calculi. The primary areas of evaluation were patient background, stone characteristics, perioperative factors, and postoperative evaluation results. The proportion of women was significantly lower (24.4% vs 37.2%; P = 0.01) and the proportion of multiple stone cases was significantly higher (34.9% vs 19.2%; P < 0.001) in the experimental as compared to the control group, while there were no significant differences for patient background or stone characteristics. The percentages of short-term preoperative stent insertion (72.0% vs 33.0%; P = 0.009) and negative preoperative urine culture cases (58.0% vs 23.0%; P < 0.001) were significantly higher in the experimental than in the control group, with no differences regarding other perioperative factors. There was no significant difference for complete stone clearance rate between the groups (P = 0.339), while only one patient underwent re-catheterization and there were no cases of urinary retention. Interestingly, the rate of postoperative febrile urinary tract infection was significantly lower (P = 0.024) in the experimental (5.7%) than in the control (9.0%) group. Postoperative urethral catheterization can be eliminated in low-risk ureterorenoscopic lithotripsy cases, although additional studies are needed.

MP65-09 IMPACT OF PERI-OPERATIVE ANTIBIOTIC CHOICE ON INFECTIOUS COMPLICATIONS AFTER PCNL - A PROSPECTIVE RANDOMIZED TRIAL

You have accessJournal of UrologyStone Disease: Surgical Therapy V (MP65)1 Sep 2021MP65-09 IMPACT OF PERI-OPERATIVE ANTIBIOTIC CHOICE ON INFECTIOUS COMPLICATIONS AFTER PCNL - A PROSPECTIVE RANDOMIZED TRIAL Henry Wright, Naveen Kachroo, Rajat Jain, Omar Mohammed, Donald Fedrigon, Anna Zampini, Smita De, Mark Noble, Manoj Monga, Wahib Isac, and Sri Sivalingam Henry WrightHenry Wright More articles by this author , Naveen KachrooNaveen Kachroo More articles by this author , Rajat JainRajat Jain More articles by this author , Omar MohammedOmar Mohammed More articles by this author , Donald FedrigonDonald Fedrigon More articles by this author , Anna ZampiniAnna Zampini More articles by this author , Smita DeSmita De More articles by this author , Mark NobleMark Noble More articles by this author , Manoj MongaManoj Monga More articles by this author , Wahib IsacWahib Isac More articles by this author , and Sri SivalingamSri Sivalingam More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002105.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The American Urological Association guidelines recommend peri-procedural antibiotics for percutaneous nephrolithotomy (PCNL), yet it is not clear which is superior. Given the risk of infectious complications after PCNL, we prospectively compared two common antibiotics: ciprofloxacin (cipro) versus cefazolin, on PCNL outcomes, focusing on the presence of systemic inflammatory response syndrome (SIRS) criteria. We hypothesized that the use of cipro will result in less infectious complications due to its broader spectrum for UTI coverage. METHODS: Adult patients undergoing PCNL were randomized to receive either cipro or cefazolin peri-operatively. All had negative pre-operative urine cultures. Demographic and peri-operative data were collected, including SIRS criteria, intra-operative urine culture, duration of hospitalization, and need for intensive care. SIRS is defined by ≥2 of the following: body temperature < 96.8 °F or >100.4 °F, heart rate > 90 bpm, respiratory rate >20 per minute, WBC count <4000 or > 12,000 cells/mm³. Wilcoxon-Mann-Whitney was used to compare continuous variables and a Chi-square test or Fisher’s exact test was used to compare categorical variables. All statistical analysis was performed using SPSS version 26 (IBM). RESULTS: One hundred twenty-two patients were enrolled and randomized (69 cefazolin, 53 cipro). Mean age was higher in the cipro group (61 vs. 57, p=0.02). All other pre-operative characteristics were similar (p>0.05). Intra and post-operative findings were similar, with no difference between groups (p>0.05), including the number of patients meeting SIRS criteria. There were 3 positive intra-operative urine cultures in the cefazolin group, versus none in the cipro group, although this was not significant (p=0.26). One patient required intensive care in the cipro group, versus none in the cefazolin group. There were no Clavien-Dindo ≥3 complications, and no adverse reactions to either antibiotic. CONCLUSIONS: Despite the relatively broader coverage for urinary tract pathogens with cipro, this prospective trial did not show superiority over cefazolin. Accordingly, we reject our hypothesis as this data shows cefazolin and cipro appear to have equal effects on post PCNL SIRS outcomes, allowing for more options with peri-operative antibiotic prophylaxis. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1122-e1122 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Henry Wright More articles by this author Naveen Kachroo More articles by this author Rajat Jain More articles by this author Omar Mohammed More articles by this author Donald Fedrigon More articles by this author Anna Zampini More articles by this author Smita De More articles by this author Mark Noble More articles by this author Manoj Monga More articles by this author Wahib Isac More articles by this author Sri Sivalingam More articles by this author Expand All Advertisement Loading ...

Risk Factors for Systemic Inflammatory Response Syndrome in Patients with Negative Preoperative Urine Culture after Percutaneous Nephrolithotomy.

To explore the risk factors for systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL) in patients with preoperative negative urine culture (UC). Observational study. Department of Urology, Gazi Hospital, Samsun, Turkey, from January 2015 to January 2020. Two hundred and twenty-eight patients, who underwent conventional PCNL for renal stones, were evaluated. The patients were divided into non-SIRS (Group 1) and SIRS (Group 2) groups, and the effects of the variables were investigated to predict the development of SIRS. Despite preoperative sterile UC, SIRS developed postoperatively in 29 (12.7%) patients. The univariate analysis revealed a statistically significant difference between groups in preoperative serum C-reactive protein (CRP) (p <0.001), platelet-to-lymphocyte ratio (PLR) (p <0.001), neutrophil-to-lymphocyte ratio (p = 0.001), urine white blood cell (p = 0.034), stone size (p = 0.023), operative time (p = 0.041), hemoglobin drop (p <0.001), blood transfusion (p = 0.002), hospital stay (p = 0.006), and complication rate (p = 0.001). Receiver operating characteristic analysis indicated that PLR >117.36 (p <0.001), CRP >3.16 mg/L (p <0.001), stone burden >471 mm2 (p = 0.023) and hemoglobin drop >2.3 g/L (p <0.001) are independent risk factors for post-operative SIRS after PCNL. PLR, CRP, stone size, and hemoglobin drop can predict SIRS after PCNL. This finding may help classify risk in patients before PCNL, especially in those with a sterile urine culture. Key Words: C-reactive protein, Percutaneous nephrolithotomy, Platelet/lymphocyte ratio, Systemic inflammatory response syndrome.

Levofloxacin: Is It Still Suitable as an Empirically Used Antibiotic During the Perioperative Period of Flexible Ureteroscopic Lithotripsy? A Single-center Experience with 754 Patients.

To determine the empirical usage of antibiotics and analyze the pathogen spectrum during the perioperative period of flexible ureteroscopic lithotripsy (FURSL) with a focus on levofloxacin. This retrospective analysis included 754 patients who underwent FURSL successfully in our hospital from January 2015 to July 2019. All patients were indicated urine cultures and prescribed antibiotics during the perioperative period. Patients with negative preoperative urine cultures were divided into levofloxacin (LVXG) and non-levofloxacin groups (NLVXG) based on the empirical use of antibiotics. Operative time, the length of postoperative hospital stays and total hospital stays, total hospitalization costs, postoperative fever rate and removal rate of stones were compared. Patients with positive urine cultures were analyzed for pathogen distribution and antibiotic resistance. In the empirical use of antibiotics among 541 cases with negative urine cultures, the prescription rate of levofloxacin was 68.95%. Compared to that in NLVXG, LVXG had a lower cost of antibiotics but higher postoperative fever rate and longer hospital stay. There were no significant differences in operative time, the total hospitalization costs and the removal rate of stones between the two groups. The top two common pathogens were Escherichia coli (36.11%) and Enterococcus faecalis (24.07%), with resistance rates of 74.36% and 71.15% to levofloxacin, respectively. Levofloxacin might be no longer suitable as the first-line choice of clinical experience when performing FURSL in our center.

The evaluation of early predictive factors for urosepsis in patients with negative preoperative urine culture following mini-percutaneous nephrolithotomy.

To identify early predictive factors for urosepsis secondary to mini-percutaneous nephrolithotomy (MPCNL) in patients with negative preoperative urine culture (UC). A total of 786 patients with baseline negative UC who underwent MPCNL between January 2017 and June 2019 were retrospectively analyzed. Urosepsis was defined according to the Sepsis-3 definition. Subsequently, perioperative potential risk factors were compared between non-urosepsis and urosepsis groups. Despite negative UC in all patients, the rate of positive stone culture (SC) was 16.0%; the rate of pelvic urine culture (PUC) was 7.5%; 23 cases (2.9%) developed urosepsis after MPCNL. Univariate analysis showed that urosepsis was associated with the female gender, BMI, stone burden, diabetes mellitus and preoperative urine test. Multivariate logistic regression analysis suggested that urine test with positive nitrite and white blood cells and leukocyte esterase (N+WBC+LE+) (OR 17.51, 95% CI 6.75-45.38, P < 0.001) and operative time > 120min (OR 3.53, 95% CI 1.41-8.85, P = 0.007) were independent risk factors for urosepsis. Additionally, receiver operating characteristic curve analysis of N+WBC+LE+ showed that the area under the curve was 0.785 for predicting the occurrence of urosepsis. Further analysis showed that N+WBC+LE+ provided an efficient prediction of SC+/PUC+ (SC+ or PUC+) with 61.7% sensitivity and 97.3% specificity. In spite of the baseline negative preoperative UC, 2.9% of patients developed urosepsis after MPCNL. N+WBC+LE + was determined to be an early and efficient prediction of intraoperative bacterial status and urosepsis following MPCNL. Nevertheless, further studies are needed to confirm the results.

Role of cultural analysis in patients with indwelling ureteral stent submitted to ureteroscopy for stones.

Aim of our study is to analyze the incidence of postoperative infectious complications and to assess its predictors in patients with indwelling ureteral stent treated with ureteroscopy (URS). We retrospectively evaluated data of patients treated with URS from January 2017 to July 2018 at our center. We included 88 consecutive patients with available stent culture (SC) and urine culture (UC). Cefoxitin 2 g IV was given as prophylaxis in all patients with negative preoperative UC; otherwise, the choice of antibiotic was based on antibiogram. Ureteral stent was removed before URS procedure and analyzed. No postoperative antibiotic was given. Multivariable logistic regression analysis was built to assess preoperative predictors of postoperative infectious complications. Nineteen patients (22%) developed postoperative infectious complications and fever was the most common one. E. faecalis, which is not responsive to common prophylaxis schemes in force in our institution, was the most frequent pathogen isolated. Overall, 26% of patients were found to have a discordance between SC and UC. At multivariable logistic regression analysis preoperative SC positivity (Odds Ratio [OR]: 11.00, 95% Confidence Interval [CI]:1.08-111.41, P=0.04) was the only significant predictor of postoperative infectious complications. About one to five patients treated with URS developed an infectious complication and E. faecalis and E. coli were the most frequent pathogen isolated. A positive SC is the only independent risk factor for postoperative infection: consequently, an early SC analysis could allow a prompt antibiotic therapy in all patients with positive SC even if mildly symptomatic.

Predictive factors of infectious complications in the postoperative period of percutaneous nephrolithotomy

ObjectiveInfectious complications (IC) following percutaneous nephrolithotomy surgery (PCNL) can be life-threatening. Our objective was to analyze preoperative predictors of IC in PCNL. Materials and methodsA total of 203 patients who underwent PCNL were included in a prospective study between January 2013 and February 2016. A postoperative IC was defined as urinary infection/pyelonephritis, systemic inflammatory response syndrome or sepsis. The variables analyzed were age, gender, number, size (cm) and side of stone; Hounsfield units, diabetes (insulin dependent or not), preoperative culture, isolated bacteria, multitract, body mass index and surgical time (min). A multivariate forward stepwise (logistic regression) was performed. ResultsIC occurred in 30 patients (14.8%): 9 (4.4%) had urinary infection, 14 (6.9%) systemic inflammatory response syndrome and 7 (3.5%) sepsis. In addition, 13 (43.3%) had negative preoperative urine culture, 15 (50%) positive and in 2 (6.7%) was not available. On the logistic regression analysis, stone size (cm), insulin dependent diabetes and female sex were independently associated with increased risk of IC (odds ratio [OR] 1.03, 14.6 and 7.8, respectively; p=0.0001). ConclusionsPatients with large stone burdens, insulin–dependentdiabetes condition and female gender, should be counselled properly regarding postoperative infection risks and closely followed up to diagnose IC (specially sepsis) soon enough. Negative preoperative urine culture seems not reliable enough to exclude an infectious complication according to our results.

Factores predictores de complicaciones infecciosas en el postoperatorio de la nefrolitotomía percutánea

ObjectiveInfectious complications (IC) following percutaneous nephrolithotomy surgery (PCNL) can be life-threatening. Our objective was to analyse preoperative predictors of IC in PCNL. Materials and methodsA total of 203 patients who underwent PCNL were included in a prospective study between January 2013 and February 2016. A postoperative IC was defined as urinary infection/pyelonephritis, systemic inflammatory response syndrome or sepsis. The variables analysed were age, gender, number, size(cm) and side of stone; Hounsfield units,diabetes (insulin dependent or not), preoperative culture, isolated bacteria, multitract, bodymass index and surgical time (min). A multivariate forward stepwise (logistic regression) was performed. ResultsIC occurred in 30 patients (14.8%): 9 (4.4%) had urinary infection, 14 (6.9%) systemic inflammatory response syndrome and 7 (3.5%) sepsis. In addition, 13 (43.3%) had negative preoperative urine culture, 15 (50%) positive and in 2 (6.7%) was not available. On the logistic regression analysis, stone size (cm), insulin dependent diabetes and female sex were independently associated with increased risk of IC (odds ratio [OR] 1.03, 14.6 and 7.8, respectively; P=.0001). ConclusionsPatients with large stone burdens, insulin diabetes condition and female gender, should be counselled properly regarding postoperative infection risks and closely followed up to diagnose IC (specially sepsis) soon enough. Negative preoperative urine culture seems not reliable enough to exclude an infectious complication according to our results.

A Randomized Controlled Trial of Preoperative Prophylactic Antibiotics Prior to Percutaneous Nephrolithotomy in a Low Infectious Risk Population: A Report from the EDGE Consortium

Single institution studies suggest a benefit of a week of preoperative antibiotics prior to percutaneous nephrolithotomy. These studies are limited by lower quality methodology, such as the inclusion of heterogeneous populations or nonstandard definitions of sepsis. The AUA (American Urological Association) Best Practice Statement recommends less than 24 hours of intravenous antibiotics but to our knowledge no other data exist on the duration or benefit of preoperative antibiotics. Using CONSORT (Consolidated Reporting of Trials) guidelines we sought to perform a rigorous multi-institutional trial to assess preoperative antibiotics in patients in whom percutaneous nephrolithotomy was planned and who were at low risk for infection. This randomized controlled trial enrolled patients undergoing percutaneous nephrolithotomy who were at low risk, defined as negative preoperative urine cultures and no urinary drain. Of the subjects 43 were randomized to nitrofurantoin 100 mg twice daily for 7 days preoperatively while a control arm of 43 received no oral antibiotics. All subjects received perioperative doses of ampicillin and gentamicin. Prone percutaneous nephrolithotomy was performed by urologists blinded to randomization. The primary outcome was the development of sepsis. A total of 86 subjects were enrolled. Preoperative patient characteristics were similar in the treatment and control cohorts with a stone size of 19 and 17 mm, respectively (p = 0.47). Intraoperative characteristics also did not differ. The sepsis rate was not statistically different between the treatment and control groups (12% and 14%, respectively, 95% CI -0.163-0.122, p = 1.0). Other infectious parameters and complications were similar, including intensive care admission, fever, hypotension and leukocytosis. Our study demonstrated no advantage to providing 1 week of preoperative oral antibiotics in patients at low risk for infectious complications who undergo percutaneous nephrolithotomy. Perioperative antibiotics according to the AUA Best Practice Statement appear sufficient.

American Urological Association Antibiotic Best Practice Statement and Ureteroscopy: Does Antibiotic Stewardship Help?

To determine compliance with the American Urological Association (AUA) antimicrobial prophylaxis best practice statement and whether the use of postoperative antibiotics is associated with lower rates of postoperative urinary tract infection (UTI) in patients with nephroureterolithiasis and a negative preoperative urine culture undergoing ureteroscopy. A retrospective review of all adult patients undergoing ureteroscopy from 2013 to 2014 for stone disease with a negative preoperative urine was conducted. Patients who did and did not receive postoperative oral antibiotics beyond 24 hours of surgery were identified. The rates of culture-proven postoperative UTI and unplanned postoperative encounters were determined for both groups. Between-group comparisons were made by using independent t-test and Chi-square analyses. A total of 1068 patients met inclusion criteria and 31.6% were managed in accordance with the AUA best practice statement by not receiving antibiotics beyond 24 hours of surgery. Overall, 33 patients developed a culture-proven UTI within 30 days after surgery, with no difference in UTI rate between patients who did and did not receive home-going antibiotics (2.9% vs 3.6%, respectively; p = 0.5). Rates of unplanned hospital encounters also did not differ between groups (23.7% vs 27.0%, respectively; p = 0.2). On multivariate regression, culture-proven UTI within 1 year before surgery was the only factor associated with postoperative UTI (odds ratio: 10.8, p < 0.0001). Patients who did and did not receive home-going antibiotics after ureteroscopy demonstrated similar rates of postoperative UTI and unplanned hospital encounters. These results suggest that there is no benefit to extended antibiotics after ureteroscopy. The minority of patients managed in accordance with the AUA best practice statement highlights room for quality improvement.

MP26-11 IS PRE-OPERATIVE URINE CULTURE SUFFICIENT TO PREDICT SEPTIC COMPLICATIONS OF PERCUTANEOUS NEPHROLITHOTOMY?

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder II1 Apr 2016MP26-11 IS PRE-OPERATIVE URINE CULTURE SUFFICIENT TO PREDICT SEPTIC COMPLICATIONS OF PERCUTANEOUS NEPHROLITHOTOMY? Marouene Chakroun, Walid Kerkeni, Abderrazak Bouzouita, Haroun Ayed, Mohamed Cherif, Amine Derouiche, Mohamed Riadh Ben Slama, and Mohamed Chebil Marouene ChakrounMarouene Chakroun More articles by this author , Walid KerkeniWalid Kerkeni More articles by this author , Abderrazak BouzouitaAbderrazak Bouzouita More articles by this author , Haroun AyedHaroun Ayed More articles by this author , Mohamed CherifMohamed Cherif More articles by this author , Amine DerouicheAmine Derouiche More articles by this author , Mohamed Riadh Ben SlamaMohamed Riadh Ben Slama More articles by this author , and Mohamed ChebilMohamed Chebil More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2948AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Preoperative urine culture is essential before urologic surgery; its positivity may be associated with a high risk of postoperative complications. Our objective was to evaluate the incidence and the severity of septic complications after percutaneous nephrolithotomy (PNL), and determinate whether preoperative urine culture was predictive of these complications. METHODS We retrospectively analyzed data of 277 patients who had undergone PNL between 2009 and 2014. Septic complications occurred after surgical procedure were reported and then classified according to severity using the Clavien-Dindo classification. Univariate analysis was used to assess the impact pre-operative urine culture on the occurrence of septic complications. RESULTS The median age was 46 years (9 – 80). %). The median size of the stone was 30.69 mm (10-70). The average operative time was 167.38 mn (75-300). Complications occurred in 139 patients (55.37%), septic ones in 69 patients (24.9%), including 6 cases of retroperitoneal phlegmon (2.16%), one case of renal abscess (0.36%), 3 cases of pyelonephritis (1.08%), and 4 cases of prostatitis (1.44%). Fever with no etiology has been reported in 56 cases, it was considered as a septic complication. According to severity, grade 4 complications have been reported in 3 patients (1.08%), with recovery after resuscitation. Preoperative urine culture was positive in 17 patients (6.13%); all had peri-operative antibiotherapy adapted to the antibiogram. Seven of these patients (41.17%) had septic complications. In univariate analysis, preoperative urine culture was not predictive of septic complications (OR=1.27; p = 0.242). CONCLUSIONS Pre-operative urine culture was not sufficient to predict septic complications after PNL. Most patients who presented with septic complications post-operatively had negative preoperative urine culture. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e358 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Marouene Chakroun More articles by this author Walid Kerkeni More articles by this author Abderrazak Bouzouita More articles by this author Haroun Ayed More articles by this author Mohamed Cherif More articles by this author Amine Derouiche More articles by this author Mohamed Riadh Ben Slama More articles by this author Mohamed Chebil More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Efficacy and safety of retrograde flexible ureteroscopic lithotripsy with holmium: YAG laser in the treatment of renal stones

Objective To evaluate the efficacy and safety of retrograde flexible ureteroscopic lithotripsy (RFUL) with holmium: YAG laser for the treatment of renal stones with a large series. Methods The data of 466 patients who underwent RFUL with holmium: YAG laser for the treatment of kidney stones between January 2013 and December 2013 were collected.The maximum diameter of stone was 23±16 mm.The stone free rate, complications, retreatment rate were evaluated. Results Out of the 466 patients, the mean operative time and postoperative hospital stay were 33.5±18.8 min and 2.3±2.0 d. The stone free rate was 67.6% (315/466) after single procedure, which increased to 69.5% (324/466) via re-treatments after 3 months.The retreatment rate was 4.3% (20/466), with a total of 493 RFUL procedures performed and 1.06 times per patient.There were 67 (14.4%) cases undergoing complications.Five cases had false passage of ureter orifice causing slight ureteral wall injuries. Steinstrasse occurred in 9 cases, ureteral perforation in 3 cases and perirenal hematoma in 1 case.Overall postoperative fever rate was 10.7% (50/466) with urosepsis in 16 cases (3.4%). When the stone size was ≤10, 11-20, 21-30, 31-40, and >40 mm, the stone free rates after a single procedure were 97.0% (65/67), 84.2% (160/190), 63.1% (70/111), 29.2% (14/48), 12.0% (6/50) (P<0.001), and the postoperative fever rates were 1.5% (1/67), 9.5% (18/190), 13.5% (15/111), 14.6% (7/48), 18.0% (9/50), respectively. The postoperative fever rates were 19.3% (27/140) and 7.1% (23/326) (P<0.001) in the patient with positive and negative preoperative urine leukocyte, and 22.0% (22/100) and 7.7% (28/366) (P<0.001) in patients with positive and negative preoperative urine culture. Conclusions RFUL with holmium: YAG laser is a safe and effective treatment for kidney stones. The postoperative fever rate would increase and stone free rate would reduce with the increased stone size. Key words: Flexible ureteroscopy; Lithotripsy, laser; Kidney calculi; Stone free rate; Complications

MP80-04 CULTURING THE RIGHT MICROORGANISMS IN PATIENTS UNDERGOING PERCUTANEOUS NEPHROLITHOTOMY (PCNL) AND FLEXIBLE URETEROSCOPY (FURS) FOR RENAL STONES – CAN WE DO ANY MORE?

You have accessJournal of UrologyStone Disease: Evaluation II1 Apr 2015MP80-04 CULTURING THE RIGHT MICROORGANISMS IN PATIENTS UNDERGOING PERCUTANEOUS NEPHROLITHOTOMY (PCNL) AND FLEXIBLE URETEROSCOPY (FURS) FOR RENAL STONES – CAN WE DO ANY MORE? Rehan Khan, Sarah Hunt, Holly Bekarma, Alison Ramsay, and Sarath Krishna Nalagatla Rehan KhanRehan Khan More articles by this author , Sarah HuntSarah Hunt More articles by this author , Holly BekarmaHolly Bekarma More articles by this author , Alison RamsayAlison Ramsay More articles by this author , and Sarath Krishna NalagatlaSarath Krishna Nalagatla More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2840AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES PCNL and FURS for renal stones can be a morbid procedure in view of urosepsis. Endourologists treat all positive pre-operative urine cultures with appropriate antibiotics. However, patients can still develop sepsis in the post-operative period and knowledge of the right microorganisms is not only invaluable but can also be lifesaving. Intraoperative stone cultures described as a tool to cultures the right microorganisms. Aim of this study is to assess if post op urine cultures add any information regarding culturing the right microorganisms in patients undergoing PCNL and FURS for renal stones. METHODS We prospectively collected data for patient undergoing PCNL and FURS for renal stones in our unit between August 2013 and May 2014. Demographics, details about pre-operative urine, intra- operative stone as well as post-operative urine culture were collected. Data was analysed to assess positive culture rates in each group and specifically assessed if post op urine cultures add anything to our microbiological information. RESULTS Data was collected for a total of 60 patients over the study period of 10 month period. Subsequently, only patients who had information available regarding pre-operative urine culture, intra-operative stone culture and postoperative urine cultures were included. This criteria led to exclusion of 19 patients and 41 patients were included in the final analysis. Mean age was 57 years with age range of 26 to 86 years. Pre-operative urine culture was positive in 13/41 patients (32). Intraoperative stone culture was positive in 8/41 patients (20%). Postoperative urine culture was positive in 6/41 patients (15%). One patient had exclusively postoperative urine culture and negative pre-operative urine and intraoperative stone culture and this correlated with postoperative sepsis. CONCLUSIONS Our study indicates that postoperative urine cultures add to our knowledge regarding the right microorganisms in patients undergoing PCNL and FURS for kidney stones and should be carried out routinely to allow appropriate management of postoperative urinary sepsis. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1020 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rehan Khan More articles by this author Sarah Hunt More articles by this author Holly Bekarma More articles by this author Alison Ramsay More articles by this author Sarath Krishna Nalagatla More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Intra-operative stone culture as an independent predictor of systemic inflammatory response syndrome after percutaneous nephrolithotomy

To evaluate the correlation between preoperative urine culture and stone culture findings during PCNL and choosing the appropriate antimicrobial treatment of patients with urinary tract infection or SIRS after PCNL. From April 2007 to March 2008, 51 patients aged 24-66 years underwent PCNL under general anesthesia. Statistical analysis was performed using SPSS software (v.18), the Kolmogorov-Smirnov test, Student's t test, and the Chi square or Fisher's exact tests. Before operation, 11 patients (21.6 %) had positive urine culture. Sixteen patients (31.4 %) had positive stone culture during operation. SIRS occurred in 13 patients (25.5 %). In female group (10 cases, 45.5 %), SIRS was significantly higher than male group (3 cases, 10.3 %) (P = 0.008). Positive stone culture was significantly more prevalent in cases with positive pre-operative urine culture than cases with negative pre-operative urine culture (P = 0.023). But positive stone culture in group with SIRS, was significantly more common than group without SIRS (P = 0.001). Also positive stone culture in female group had significantly higher than male group (P = 0.003). We found a significant, tenfold increase in the risk of developing SIRS after PNCL, only in patients with positive stone culture (OR = 9.96; 95 % CI = 2.37-41.85, P = 0.002). Positive stone culture is a significant predictor of SIRS after PCNL, regardless of other related factors. Therefore, in order to avoid using blind empirical antibiotic regimen and to reduce the risk of subsequent microbial resistance due to use of prevalent broad-spectrum antibiotics, it would be wise to choose appropriate antibiotic therapy based on the results of intraoperative stone culture.

The outcome of urine culture positive and culture negative staghorn calculi after minimally invasive percutaneous nephrolithotomy

The purpose of this study was to compare the treatment outcomes of staghorn stones using minimally invasive percutaneous nephrolithotomy (MPCNL) in patients who had positive preoperative urine culture to patients with negative urine culture. The records of 284 patients with staghorn calculi, who underwent MPCNL in our center from January 2012 to January 2013, were retrospectively analyzed. Patients were divided into positive and negative group, according to the result of preoperative urine culture. Staghorn stones with negative culture received a single dose of broad spectrum antibiotic prophylaxis, whereas stones with positive culture were treated for at least 72 h according to antibiogram. The perioperative findings and postoperative outcomes were compared between the two groups. There were 70 (24.6%) patients with positive and 214 (75.4%) patients with negative preoperative urine culture who underwent MPCNL. There were no statistical differences in the duration of hospital stay, operative time, estimated blood loss, final stone free rate (SFR) as well as the incidence of the following infectious complications such as fever, systemic inflammatory response syndrome and septic shock, between both groups. Our retrospective study showed that MPCNL was a safe and effective modality in the treatment of staghorn stones. The morbidity, complication, and SFR were similar between patients with positive and negative preoperative urine cultures, once the culture positive infections were adequately controlled.