Preoperative Culture Research Articles

MP39-14 IS A PREOPERATIVE POSTIVE URINE CULTURE A PREDICTOR OF PENILE PROSTHESIS INFECTION?

You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy II (MP39)1 Apr 2020MP39-14 IS A PREOPERATIVE POSTIVE URINE CULTURE A PREDICTOR OF PENILE PROSTHESIS INFECTION? Kevin Parikh*, Steven Lomax, James Schnell, Jordan Bullock, and Gregory Broderick Kevin Parikh*Kevin Parikh* More articles by this author , Steven LomaxSteven Lomax More articles by this author , James SchnellJames Schnell More articles by this author , Jordan BullockJordan Bullock More articles by this author , and Gregory BroderickGregory Broderick More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000888.014AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: At our institution, all patients undergoing inflatable penile prosthesis (IPP) surgery have a pre-operative urine culture drawn prior to surgery. If these cultures are positive, these patients are treated with appropriate antibiotics prior to surgery in an attempt to decrease the risk of infection. A recent publication by Kavoussi et. al showed that 18% of patients undergoing penile prosthesis surgery had a positive pre-operative urine culture and that there was no correlation with the bacteriology of prosthetic infections. The purpose of our study is to determine how common a positive urine culture during preoperative evaluation for patients undergoing IPP surgery and if there is any association between preoperative culture rates and the risk of infection. METHODS: A retrospective review of IPP surgeries between 2013 and 2018 was performed. These IPP surgeries included both virgin and revision penile prosthesis surgeries. Patients with a preoperative urine culture within 30 days of surgery were included in the analysis. A positive urine culture was recorded if an identifiable bacteria was grown from the urine, regardless of quantity. Surgical outcomes of a postoperative infection was documented along with intraoperative culture data at time of revision. Statistical analysis was performed to determine preoperative positive urine culture rates and also if there was any correlation with a positive urine culture and postoperative infection. RESULTS: The cohort consisted of a total of 257 patients, both virgin and revision IPP. This patient cohort consisted of 30% diabetics (77/257). A positive urine culture was found in 4.6% (12/257) patients. The rate of postoperative infection in this medically complex patient cohort was 4.4% (11/257). Of those with a positive urine culture, only 1 of those patients (1/12, 8.3%) developed a postoperative infection. The preoperative urine culture organism was not the same organism that was cultured at the time of the explanation surgery. The association between a preoperative culture and postoperative infection was not statistically significant (P=0.49). CONCLUSIONS: In our retrospective study, positive preoperative urine culture did not show a statistically significant association with postoperative infection or any correlation with the actual bacteria cultured at time of explant surgery. Preoperative urine culture rates were much lower in this study when compared to rates previously reported in the literature. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e582-e582 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Parikh* More articles by this author Steven Lomax More articles by this author James Schnell More articles by this author Jordan Bullock More articles by this author Gregory Broderick More articles by this author Expand All Advertisement PDF downloadLoading ...

Cutaneous microbiology of patients having primary shoulder arthroplasty

Shoulder periprosthetic infections are predominantly caused by bacteria residing in the skin of healthy individuals. Knowledge of the factors associated with the loads of the different cutaneous bacteria in individuals having shoulder arthroplasty may help identify patients at higher risk of periprosthetic infection and help guide preventive measures. For this reason, we tested the hypothesis that easy-to-obtain preoperative characteristics were significantly associated with the cutaneous microbiology and the loads of specific bacteria in shoulders having joint replacement. This study identified the microbiology of the unprepared epidermal skin surface and of the dermal edge freshly incised at surgery in 332 patients having primary shoulder arthroplasty. The load of bacteria in each sample was characterized as a value based on the laboratory report: 0 for "no growth"; 0.1 for "one colony only" or for "broth only"; and 1, 2, 3, and 4 for 1+, 2+, 3+, and 4+ growth, respectively. The relationships between preoperative patient characteristics and these semiquantitative results of the cutaneous cultures were analyzed. Cultures of the unprepared epidermal skin surface showed positive results for a wide variety of organisms, including Cutibacterium in 72%, coagulase-negative Staphylococcusin 61%, and a spectrum of other organisms in 32%. By contrast, cultures of the freshly incised dermal edge showed a great preponderance of Cutibacterium (34%) in comparison to low levels of coagulase-negative Staphylococcus(8%) and other organisms (2%). An increased dermal load of Cutibacterium was significantly associated with male sex, younger patient age, American Society of Anesthesiologists class 1, use of testosterone supplements, prior shoulder surgery, and higher Cutibacterium loads on the unprepared skin surface. Although the microbiology of the unprepared skin surface is diverse, the same is not true for the freshly incised dermis, where Cutibacterium is the predominant organism. Readily available preoperative patient characteristics are significantly associated with the load of Cutibacterium in the incised dermis. Preoperative cultures of the unprepared skin surface appear to be a new method for predicting the type and load of bacteria found in the freshly incised dermis at the time of surgery. Additional studies are needed to determine whether preoperative cultures of the unprepared epidermal skin surface can provide a method for identifying patients at increased risk of shoulder periprosthetic infections.

Pulmonary resection for nontuberculous mycobacterial pulmonary disease: outcomes and risk factors for recurrence.

As the number of patients with nontuberculous mycobacterial pulmonary disease (NTMPD) increases, surgical treatment to control disease becomes more important. However, postoperative outcomes and predictors of recurrence have been insufficiently evaluated. We retrospectively investigated 100 patients with NTMPD who underwent pulmonary resection from 2009 to 2016 at our institution. Clinical data of patients with and without postoperative recurrence were statistically compared. Recurrence was defined as microbiological re-identification or computed tomography findings highly suspicious for relapse after excluding other diseases. Recurrence-free survival was calculated using the Kaplan-Meier method. Survival curves were compared using the log-rank test. Predictive factors were evaluated using univariate and multivariate analyses. Nine patients experienced recurrence. A significant difference in recurrence-free survival was detected between patients with and without a positive preoperative sputum culture (P = 0.000942). Moreover, patients with a positive preoperative sputum smear (≥ 2 +) had a significantly higher recurrence rate than those who did not (P = 0.000216). Multivariate analysis revealed that preoperative sputum smear (≥ 2 +) is an independent risk factor for recurrence after pulmonary resection for NTMPD (odds ratio, 7.38; 95% confidential interval, 1.29-42.2; P = 0.024). NTM discharge might have an impact on postoperative recurrence of NTMPD patients without residual cavitary lesions. Preoperative NTM discharge should be minimized by optimizing medical therapy before surgical treatment to improve the postoperative course. Intensive follow-up and prolonged postoperative medical therapy should be considered for patients without a sufficient reduction in bacterial discharge before pulmonary resection.

Confusion bias and seasonal variation of exogenous endophthalmitis incidence.

We read with interest the study by Kim et al. in which they analyzed postoperative endophthalmitis incidences in South Korea from July 2014 to June 2017.1 A total of 951 (0.064%) of 1 498 548 cataract procedures were identified as presumed postoperative endophthalmitis cases. The researchers found that rates were higher in July, during the summer months and when relative humidity and the precipitation level were also higher. The differences in incidence among seasons were statistically significant. It has been known for decades, and more recently confirmed, that the microorganisms that cause postoperative endophthalmitis usually come from the patient's own conjunctival and eyelid flora that enters the eye through the incision during the procedure or within a short time span after the procedure.2–4 Therefore, as the authors commented, the reason as to why postoperative endophthalmitis showed seasonal variation is not straightforward. Many variables could play a role, but undoubtedly it could also have been the result of a confusion bias, leading to an overestimation of the actual association with the summer time. The difficulty lies in identifying that third variable (confounding factor) that was not controlled. Possibly pertinent questions in this regard would be as follows: do all clinics operate throughout the year, or some close during the summer? Is it possible that those that close during the summer time have different prophylaxis protocols (v.gr. intracameral antibiotics) and/or the incidence of endophthalmitis in those clinics that do not operate during the summer was much lower throughout the year?5 Do the same surgeons perform surgeries in summer, or are more procedures performed by surgeons in training during that time? Is the rate of intraoperative complications the same during the summer? Is there an influx of patients who are going to have surgery in South Korea, coming from other countries, during the summer? The exclusion of these possible confounding factors would serve to strengthen the finding of a real association between the incidence of acute postoperative endophthalmitis and the seasons of the year. Further studies would be required to confirm some of the possible explanations suggested by the researchers: for example, that the conjunctival flora is different. Preoperative cultures of patients undergoing cataract surgery could be performed throughout the year, which would generate valuable information. On another note, a false inference can be made when information at the collective or group level is incorrectly assumed at the individual level. This would imply a multilevel analysis, the environmental variables being the contextual ones. The association under study had to consider the hierarchical structure of the data, both individually and collectively to avoid the occurrence of an ecological fallacy. The huge sample size also attracted our attention. With almost 1.5 million observations, it is very easy to find statistically significant bivariate associations, which can be spurious (ie, lacking authenticity or validity). The association is not synonymous with causation. A rigorous multivariate analysis would be required, and the variables of the model should not only be included based on purely mathematical criteria but also based on causality criteria, to respect the principle of parsimony.

Increased Detection of Polymicrobial Infections by Sonication and Significance of Prosthesis Design and Fixation Technique in Cases of Low-Grade PJI, a Retrospective Study

Introduction: Low-grade PJI remains a diagnostic dilemma in the medical community. It is mainly caused by low-virulent bacteria that cause chronic infection. This is mainly due to the formation of biofilms on the implant surface. This biofilm formation poses a diagnostic challenge that causes difficulties in the microbiological diagnosis of the infection by conventional culture methods. Sonication culture of implants has proven to be useful for biofilm forming bacteria. Therefore, we examined the evaluation of low-grade PJI using sonication culture methods and searched for influencing factors. The methods: Between October 2016 and November 2019 we retrospectively examined adult patients with suggestive clinical and laboratory findings of low-grade PJI. The patient's medical history, demographic information, prosthesis type, laboratory findings and length of hospital stay were collected. The results of the microbiological culture were divided into the results of the conventional preoperative and intraoperative culture method and the results of the sonication. In addition, laboratory chemical diagnostics of the joint punctures and CRP determination were performed. Additionally, the influence of prosthesis design and fixation technique, with and without cement, was investigated. The Results: Fifty-two patients with a mean age of 70.5 years were included in this study. The female population was more frequently affected. The most frequently affected joints were hip and knee. A higher percentage of pathogen detection was found at sonication with 60% of positive cultures, compared to 52% of intraoperative and 40% of preoperative conventional positive culture findings. The majority of patients were monomicrobial infections, with Staphylococcus epidermidis being the most frequently detected etiologic pathogen. The sonication culture was best able to detect a polymicrobial infection in 14% of cases compared to 6% of intraoperative and 4% of preoperative conventional cultures. Patients with a polymicrobial infection showed higher CRP values (P = 0.0172) and longer hospitalization (P = 0.0017) than monomicrobial infected patients. The results of the intraoperative conventional culture showed the highest congruence with the results of the sonication culture (concordance of 79%) compared to the preoperative culture. An infectious histopathological classification confirmed the microbiological ultrasound findings in 69% of cases with an infectious category. Cemented fixation showed a trend towards less positive microbiological findings, and total hip arthroplasty showed the highest detection of bacteria by sonication culture compared to bicondylar surface knee replacement (P = 0.0072). Conclusion: The sonication culture proved to be an important microbiological diagnostic tool, especially for the detection of polymicrobial infections in cases of low-grade PJI. This method has an established place in the diagnosis of low-grade PJI. The prosthesis design and the cemented fixation technique seem to have an influence on the detection of bacteria.

Preoperative Skin Cultures Predict Periprosthetic Infections in Revised Shoulder Arthroplasties: A Preliminary Report.

Background:Current approaches do not provide a practical method for the accurate prediction of a Cutibacterium periprosthetic joint infection (PJI) in failed arthroplasties. Thus, surgeons revising failed arthroplasties must decide whether to exchange the implants and to institute antibiotic treatment without knowing the results of cultures of deep specimens obtained at the revision procedure. This study tests the hypothesis that the results of preoperative culture specimens of the skin surface obtained in the clinic can predict the presence of culture-positive Cutibacterium PJIs.Methods:Revision shoulder arthroplasties performed between October 3, 2017, and February 4, 2020, that had both preoperative clinic culture specimens and surgical culture specimens were included in this analysis. Culture results were assigned a value from 0 to 4. The percentage of the total skin bacterial load contributed by Cutibacterium (Cutibacterium percentage) was determined. To reduce concern about contamination, a robust criterion for culture-positive Cutibacterium PJI was applied: ≥2 surgical specimens with a Cutibacterium value of ≥1. The predictive values for a culture-positive Cutibacterium PJI were determined for a clinic skin culture Cutibacterium value of >1 and a clinic skin percentage of Cutibacterium of ≥75%.Results:Eighteen cases met the inclusion criteria; of these, 7 (6 male patients) met our criterion for a culture-positive Cutibacterium PJI. For all patients, a preoperative clinic skin Cutibacterium value of >1 predicted the presence of a culture-positive Cutibacterium PJI with an accuracy of 89%, and a clinic skin Cutibacterium percentage of ≥75% predicted the presence of a culture-positive Cutibacterium PJI with an accuracy of 94%. For male patients, a preoperative clinic skin Cutibacterium value of >1 predicted the presence of a culture-positive Cutibacterium PJI with an accuracy of 91%, and a clinic skin Cutibacterium percentage of ≥75% predicted the presence of a culture-positive Cutibacterium PJI with an accuracy of 100%.Conclusions:A simple culture specimen of the unprepared skin surface obtained in a clinic prior to revision shoulder arthroplasty may provide valuable assistance to surgeons planning a revision arthroplasty.Level of Evidence:Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Comparison of the Effects of Povidone-Iodine 5%, Polyhexamethylene Biguanide, and Chlorhexidine as a Preoperative Antiseptic in Endophthalmitis Prophylaxis in Patients Undergoing Phacoemulsification Cataract Surgery.

Background:This study aims to compare the efficacy and toxicity of povidone-iodine (PI) 5%, polyhexamethylene biguanide (PHMB) 0.02%, and chlorhexidine 0.02% in patients undergoing phacoemulsification cataract surgery.Materials and Methods:This single-center, randomized study was done on 330 patients who referred to Feiz hospital in Isfahan and scheduled for cataract surgery. They were assigned randomly to 1 of 3 groups of 110 eyes who received 1 drop of PI 5% in group 1, 1 drop of PHMB 0.02% in group 2 and 1 drop of chlorhexidine 0.02% in group 3. Pre-operative Cultures samples were obtained without any topical application and it was repeated 5 min after use of antiseptic solutions. Cultures were obtained from the inferior conjunctival fornix, using sterile culture swabs while avoiding contact to the eyelids and lashes.Results:The numbers of colony-forming units (CFUs) did not differ significantly among the three groups (P = 0.149 and P = 0.260, respectively). After the intervention, CFUs numbers in the three groups were decreased with a significant difference in both blood and chocolate agars (P = 0.304 and P = 0.136, respectively). Of the 317 eyes, 108 (34.1%) showed no bacterial growth in the pre-preparation period, which was similar in the three groups. Staphylococcus epidermidis was the most common isolated bacteria. Conjunctival injection was significantly different among studied groups (P = 0.0001), five patients in iodine group had severe conjunctival injection and no one in the other group. SPE was significantly fewer in chlorhexidine group than PHMB and iodine groups (P = 0.0001).Conclusion:Pretreatment with 5% Povidone-Iodine (PVI) for at least 15 min or repeated applications over 10 min is effective in the reduction of conjunctival organisms, and results in less postoperative endophthalmitis.

A sophisticated antibiotic-loading protocol in articulating cement spacers for the treatment of prosthetic joint infection: A retrospective cohort study.

ObjectivesThe optimal protocol for antibiotic loading in the articulating cement spacers for the treatment of prosthetic joint infection (PJI) remains controversial. The objective of the present study was to investigate the effectiveness of articulating cement spacers loaded with a new combination of antibiotics.MethodsA retrospective cohort study involving 114 PJI cases treated with implantation of an articulating cement spacer between 2005 and 2016 was performed. The treatment outcomes of the conventional protocol (i.e. gentamicin and vancomycin (GV protocol)) were compared with those reported using the sophisticated antibiotic-loading protocol (i.e. vancomycin, meropenem, and amphotericin (VMA protocol)).ResultsThere were 62 and 52 PJI cases treated with the GV and VMA protocols, respectively. Antimicrobial susceptibility testing revealed that 22/78 of all isolates (28.2%) in this series were resistant to gentamicin, whereas there were no vancomycin-, meropenem-, or amphotericin-resistant strains. The overall infection recurrence rates were 17.7% (11/62) and 1.9% (1/52), respectively (p = 0.006). In patients with a negative preoperative culture, there was no infection recurrence reported in the VMA cohort (0/45 (0%) vs 10/54 (18.5%) in the GV cohort; p = 0.002). Multivariate analysis indicated that the VMA protocol correlated with a decreased risk of infection recurrence compared with the GV protocol (p = 0.025).ConclusionThe sophisticated VMA protocol for the loading of antibiotics in articulating cement spacers, as part of a two-stage exchange, was associated with a reduced rate of infection recurrence. This proposed protocol appears to be safe and effective, especially in patients with negative culture results prior to the first-stage operation.Cite this article: Bone Joint Res 2019;8:526–534.

A sophisticated antibiotic-loading protocol in articulating cement spacers for the treatment of prosthetic joint infection

ObjectivesThe optimal protocol for antibiotic loading in the articulating cement spacers for the treatment of prosthetic joint infection (PJI) remains controversial. The objective of the present study was to investigate the effectiveness of articulating cement spacers loaded with a new combination of antibiotics.MethodsA retrospective cohort study involving 114 PJI cases treated with implantation of an articulating cement spacer between 2005 and 2016 was performed. The treatment outcomes of the conventional protocol (i.e. gentamicin and vancomycin (GV protocol)) were compared with those reported using the sophisticated antibiotic-loading protocol (i.e. vancomycin, meropenem, and amphotericin (VMA protocol)).ResultsThere were 62 and 52 PJI cases treated with the GV and VMA protocols, respectively. Antimicrobial susceptibility testing revealed that 22/78 of all isolates (28.2%) in this series were resistant to gentamicin, whereas there were no vancomycin-, meropenem-, or amphotericin-resistant strains. The overall infection recurrence rates were 17.7% (11/62) and 1.9% (1/52), respectively (p = 0.006). In patients with a negative preoperative culture, there was no infection recurrence reported in the VMA cohort (0/45 (0%) vs 10/54 (18.5%) in the GV cohort; p = 0.002). Multivariate analysis indicated that the VMA protocol correlated with a decreased risk of infection recurrence compared with the GV protocol (p = 0.025).ConclusionThe sophisticated VMA protocol for the loading of antibiotics in articulating cement spacers, as part of a two-stage exchange, was associated with a reduced rate of infection recurrence. This proposed protocol appears to be safe and effective, especially in patients with negative culture results prior to the first-stage operation.Cite this article: Bone Joint Res 2019;8:526–534.

Intranasal Septal Splints: Prophylactic Antibiotics and Nasal Microbiology.

Intranasal septal splints are often used in nasal septal surgeries. Routine use of postoperative antibiotics is an accepted practice, although data regarding its efficacy in preventing postsurgical complications are limited. This study aimed to examine bacterial colonization on septal splints following prophylactic antibiotic therapy and the association with postoperative infections. Fifty-five patients underwent septoplasty by a single surgeon between March 2015 and April 2016. All had intranasal septal splints and were given antibiotic prophylaxis for 7 days until removal of splints. Nasal cultures were taken before surgery, and septal splints were examined for bacterial colonization following their removal. Thirty-six patients (65%) had positive nasal culture prior to surgery. The most common isolates were Staphylococcus aureus (30%) and Enterobacteriaceae species (66%). All these patients had postoperative bacterial colonization on septal splints. In 15 patients with negative preoperative cultures, bacteria were isolated postoperatively. An increased resistance profile was documented postoperatively in 9 patients (16%), including two with multidrug resistance. In two of these patients preoperative wild-type strains acquired antibiotic resistance postoperatively. No adverse drug reactions to antibiotics were reported. Increased bacterial growth and emergence of resistant strains were observed on intranasal septal splints despite prophylactic antibiotic treatment. Nonetheless, this did not translate into clinical infection. Thus, considering antibiotics overuse and increasing bacterial resistance, further research is needed to determine the role of antibiotic prophylaxis in the setting of intranasal splints.

Diagnosis of osteoarticular tuberculosis via metagenomic next-generation sequencing: A case report.

Osteoarticular tuberculosis (OAT) may cause severe complications and disability. Due to its indolent nature, OAT is difficult to diagnose in the early stages. Diagnosis by conventional culture is time-consuming and insensitive, and polymerase chain reaction-based molecular diagnostic methods are incapable of excluding co-infections. Metagenomic next-generation sequencing (mNGS) may identify a broad spectrum of microorganisms, including Mycobacterium, bacteria and fungi, in clinical specimens. Therefore, the diagnosis of OAT may be rapidly performed using mNGS. The present study reports on a case of OAT. The patient presented with right knee swelling and pain for 1 year; his C-reactive protein levels and erythrocyte sedimentation rate were markedly elevated. Although multiple pre-operative cultures were negative, mNGS was finally used to successfully detect the underlying pathogen. The result was confirmed by other molecular biology methods and Mycobacterium culture. Anti-tuberculosis therapy was administered accordingly and the patient finally recovered. In conclusion mNGS, with the ability to detect Mycobacterium and other microorganisms in a single assay, is an emerging approach for rapidly and accurately diagnosing OAT. This method may provide significant support to guide physicians in selecting the appropriate pharmacotherapy and surgical treatments.

Outcomes of Endourologic Interventions in Patients with Preoperative Funguria

Introduction: Funguria is encountered in 1% to 5% of cultured urine specimens and may be a result of specimen contamination, colonization, or invasive infection. The characteristics and outcomes of patients with funguria undergoing endourologic intervention have not been evaluated. Materials and Methods: Patients with preoperative funguria undergoing endourologic intervention were retrospectively identified. Preoperative funguria was defined as a urine culture containing >10,000 colony forming units of fungus within 30 days of the operative intervention. Univariable and multivariable regression was performed to identify predictors of postoperative systemic inflammatory response syndrome (SIRS). Results: A total of 65 patients with preoperative funguria were identified, of whom 49 (75.4%) underwent ureteroscopy and 16 (24.6%) underwent percutaneous nephrolithotomy. Average patient age was 55.1 ± 18.3 years, body mass index was 31.8 ± 11.0, and Charlson comorbidity index was 2.52 ± 2.0. Twenty-three patients (35.4%) carried a diagnosis of neurogenic bladder, of whom 18 (27.7%) required indwelling or intermittent catheterization. In total 57 patients (87.7%) had been exposed to antibiotics in the 3 months before intervention. Eighteen (27.7%) patients met SIRS criteria postoperatively, of whom 11 (16.9%) required intensive care unit (ICU) admission. Three (4.6%) and two (3.1%) patients developed postoperative fungemia and bacteremia, respectively. All cases of fungemia were caused by Candida glabrata. On univariable analysis, presence of an indwelling catheter (p = 0.009), presence of a known neurological diagnosis (p = 0.02), presence of C. glabrata on preoperative culture (p = 0.04), and longer operative time (p = 0.04) were predictive of development of postoperative SIRS. No significant predictors were identified on multivariable analysis. Conclusions: Patients with preoperative funguria have high rates of comorbid illness, urinary catheterization, and recent exposure to antibiotics. This patient population is at high risk of perioperative infectious complications after endourologic intervention.

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.

Ureteroscopy: a population based study of clinical complications and possible risk factors for stone surgery.

IntroductionThe aim of this study was to describe the complications of ureteroscopy (URS) and to investigate whether performing URS outside normal working hours leads to increased risk for clinically significant complications.Material and methodsA cohort of 486 consecutive patients treated with URS, with a total of 567 sessions between 2009 and 2015 at Helsingborg/Ängelholm Hospital, Sweden, was analyzed. Outcome was complications within 14 days after URS treatment.ResultsWe found no increased risk of complications related to URS performed outside normal working hours. Stone-free rate (SFR) in the distal third of the ureter was 95.2% (315/331), in the middle ureter 92.8% (90/97), in the proximal ureter 84.0% (63/75) and 69.0% (40/58) in renal pelvis. The overall complication rate was 10.6% (n = 60). None of the potential risk factors for complications showed any significance when adjusted for age and gender. We found an inverse relationship between stenting and SFR (p = 0.002). The most common preoperatively cultured bacteria was Escherichia coli. With adequate antibiotics, there was no increased risk of complications. There was an increased risk of complications after URS related to age, but not with gender.ConclusionsURS in modern setting provides excellent results with adequate SFR and low morbidity. Time of day, the presence of urological specialized operating nurses did not affect the risk of complications and we found no other significant risk factors for complications. Escherichia coli was the most commonly found bacteria in preoperative cultures. The risk of complications increases with age. For patients >65 years old, this should be considered in preoperative counseling.

Diagnosis of periprosthetic joint bacterial infections by culture of sonication fluid from infected implants

This study compared the results of a culture method using sonication with those yielded by the conventional culture method, for patients with infected total knee arthroplasty (TKA). We also evaluated the usefulness of sonication for the identification of pathogens in infected TKA cases. Isolates were cultured from 13 implants that had been removed from 13 patients with infected TKA. Preoperative culture was performed on aspirated joint fluid, and during the operation, infected tissue was collected for culture. The removed prosthetic implants were cultured before and after sonication. Next, we identified the cultured bacteria using API biochemical kits and 16 S rRNA sequencing. The cultures from preoperative joint fluid and intraoperative tissue were positive in 9 of 13 cases (69.2%). For the removed implants, 10 cases were positive before sonication. After sonication, 12 cases (92.3%) had positive cultures. The pathogen most commonly isolated from the cultures was Staphylococcus aureus. This study found that a culturing workflow incorporating sonication diagnosed pathogens in patients with infected TKA with higher sensitivity than did the conventional culturing method.

Irrigation and Debridement, Modular Exchange, and Implant Retention for Acute Periprosthetic Infection After Total Knee Arthroplasty.

The role of irrigation and debridement, modular exchange, and implant retention for the treatment of periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) remains controversial. The proposed benefits of debridement, antibiotics, and implant retention, often referred to as DAIR, include reduced economic cost and morbidity of 2-stage reimplantation1. The primary disadvantage of this approach is a higher rate of failure and infection recurrence2,3. Furthermore, several authors have demonstrated inferior outcomes of 2-stage exchange revision arthroplasty after a failed attempt at limited debridement with implant retention4-6. Because of study heterogeneity, the outcomes of acute PJI treatment with irrigation and debridement and implant retention have been variable in the literature, with reported success rates ranging from 16% to 100%; overall, the success rate is around 50%3,7,8. Recently, studies evaluating outcomes of DAIR have indicated that host factors, organism type, the timing of intervention, and the duration of symptoms can influence the likelihood of success with this approach7,9-12. DAIR may be considered for all patients with early postoperative PJI or an acute hematogenous infection in the context of well-fixed implants and a healthy soft-tissue envelope. Chronic PJI should be considered an absolute contraindication to DAIR13. The patient's health status, comorbidities, and immune status also should be considered. Caution should be exercised when considering DAIR for a patient in whom preoperative cultures demonstrate a drug-resistant or highly virulent organism, because of a higher risk of failure1,9,14,15. With careful patient selection and meticulous surgical technique, it is possible to achieve success with this treatment strategy. The surgical procedure begins with a medial parapatellar approach and arthrotomy. A complete synovectomy is then performed, and remaining synovial tissue is aggressively debrided. Multiple culture samples should be obtained, and aseptic technique should be utilized to decrease contamination. The implant is interrogated to ensure stable fixation. Following adequate debridement, high-volume irrigation is performed; in cases involving irrigation and debridement with implant retention, we recommend incorporation of an antiseptic solution such as povidone-iodine. We recommend switching to a clean setup to facilitate sterile, uncontaminated closure of the wound, which is performed in a standard fashion. Meticulous attention should be paid to layered closure, and, if there is concern about delayed skin-healing, incisional negative-pressure wound therapy may be utilized.

Conventional povidone-iodine paint only technique vs. spray technique in preoperative antisepsis of anterior abdominal wall: a comparison of effectiveness and cost

Objectives To assess the effectiveness of spray technique (aqueous based solution in a reusable sprayer) and conventional paint only technique in view of reducing abdominal wall bacteria and to assess the volume of povidone-iodine used in each technique and evaluate which technique is more cost-effective. Methodology The sample included 70 patients, who had elective Gynaecological surgeries at Teaching Hospital, Kandy (2014-2015). This was a non-randomized clinical trial. In all patients, half the abdomen was prepared using the conventional technique and the other half using the new spray technique. Prepreparation and post-preparation skin swabs were taken and cultured to assess the mixed bacterial colony counts. Two output variables were measured; percentage reduction of mixed bacterial colony counts between preoperative and postoperative cultures for the two methods separately and the volume of povidone-iodine used in each method. Results The mean percentage reductions in mixed bacterial colony count in spray method: 98.78% and in the conventional paint method: 98.74%. P value for the two sample t-test was 0.963. Thus there is no significant difference between the mean percentage reductions in the mixed bacterial colony count in the two methods. The mean volume of povidone-iodine used in the spray method was 33.514ml with a corresponding P value of 0.000. Therefore the volume of povidone-iodine used in the spray method is significantly less than 50 ml that is used in the conventional method. (corresponding 95% upper bound for the CI: 34.714). Conclusion Both the conventional paint only technique and the new spray technique are equally effective in reducing abdominal wall bacteria. The volume of povidoneiodine used in the spray method is significantly less than that of the conventional method.

Role of urine analysis and radiology in the diagnosis of vesical calculi among patients of Darbhanga district, India

Background: Bladder stone is a common disease in this part of our country. This study was undertaken to find out the role of urine analysis and radiology in the diagnosis of vesical calculi and average size of penis in such patients in Darbhanga district.Methods: This study was conducted among patients admitted with features of vesical Calculi in the upgraded Department of Surgery, Dharbhanga Medical College and Hospital, Dharbhanga. SPSS software was used for data analysis.Results: On routine urine examination oxaluria was observed in 63.3% of cases. On preoperative culture of urine, E. coli was the most common bacteria isolated (36.6%). Maximum number of stones were single, and most of them were found only in bladder by plain X-ray (K.U.B.). The average length of penis came down from 17 to 0.4 inch after one month of removal of stone.Conclusions: In the study plain X-ray (K.U.B.) was to be of great value in diagnosing the presence of stone.

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.

Impact of positive preoperative urine cultures before pediatric lower urinary tract reconstructive surgery.

Children who undergo lower urinary tract reconstruction (LUTR) often have asymptomatic bacteriuria or recurrent urinary tract infections (UTI). We aimed to determine the prevalence of positive preoperative urine cultures (PPUC) before LUTR and to analyze any impact on postoperative outcomes. This retrospective review included all pediatric LUTR procedures utilizing bowel segments performed by one surgeon over 2years. Preoperative cultures were obtained 1-2days before surgery. Baseline characteristics and 90-day infection/readmission rates between patients with and without PPUC were compared using descriptive statistics, Fisher's exact, and Mann-Whitney tests with significance p < 0.05. 54 patients with mean age 10.1 ± 5.6years underwent LUTR procedures using bowel including continent catheterizable channel (85%), enterocystoplasty (81%), and/or urinary diversion (9%). PPUC was present in 28 patients (52%). Postoperatively, 20% had inpatient infections, including eight UTI, four surgical site infections, and two bloodstream infections with no difference between those with or without PPUC. Within 90days of discharge, 28% of patients were readmitted to the hospital, and there was no difference between groups. Postoperative urine cultures were positive in 83% of patients within 90days. Half of the patients undergoing LUTR have PPUC, but it does not increase the risk of postoperative infections or hospital readmissions. We believe complex LUTR can be safely performed in patients with PPUC.