Risk Factors of Infectious Complications after Flexible Uretero-renoscopy with Laser Lithotripsy
Urology Journal,
Vol. 15 No. 4 (2018),
10 July 2018
,
Page 158-163
https://doi.org/10.22037/uj.v15i4.3967
Abstract
Purpose: To determine the perioperative risk factors for postoperative infections among patients undergoing flexible uretero-renoscopy with laser lithotripsy (FURSLL). In addition, the resistance patterns of pathogens isolated from positive preoperative urine cultures were investigated.Materials and Methods: We retrospectively reviewed data from 492 consecutive patients who had undergone FURSLL for stone disease in our department. Postoperative infection was defined as fever (? 38°C) with pyuria (? 10 white blood cells per high power field), or systemic inflammatory response syndrome, or sepsis. Pre-operative and intra-operative characteristics between patients with and without postoperative infectious complications were compared using univariate analyses. Significant variables on univariate analyses were included in a multivariate
logistic regression analysis to evaluate risk factors associated with postoperative infection following FURSLL.
Results: 42 (8.5%) of 492 patients had postoperative infectious complications after FURSLL. 59 (12%) of 492 patients had a positive preoperative urine culture. 19 (32.2% of 59) patients had multidrug resistance (MDR) isolates recovered from positive preoperative urine cultures. 75% (9/12 cultures) of the positive preoperative urine cultures of patients in whom a postoperative infectious complication developed consisted of gram-negative pathogens. On multivariate analysis positive preoperative MDR urine culture (OR:4.75;95%CI:1.55-14.56; P = .006) was found to be significant with the dependent variable as the postoperative infectious complications despite appropriate preoperative antibiotic therapy.
Conclusion: We found that positive preoperative MDR urine culture is a significant risk factor for infectious complications after FURSLL. Our findings point to the need for further research on assessment of risk factors for
MDR infections to reduce the rate of postoperative infectious complications.
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References
Srisubat A, Potisat S, Lojanapiwat B, Setthawong V, Laopaiboon M. Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst Rev. 2014; CD007044.
Hyams ES, Monga M, Pearle MS et al. A prospective, multi-institutional study of flexible ureteroscopy for proximal ureteral stones smaller than 2 cm. J Urol. 2015; 193: 165-169.
Turk C, Knoll T, Petrik A, et al. Urolithiasis, 2016; Guideline / European Association of Urology. URL: http://uroweb.org/guideline/urolithiasis/
De S, Autorino R, Kim FJ et al. Percutaneous nephrolithotomy versus retrograde intrarenal surgery: a systematic review and metaanalysis.
Eur Urol. 2015; 67: 125-137.
Javanmard B, Kashi AH, Mazloomfard MM, Ansari Jafari A, Arefanian S. Retrograde Intrarenal Surgery Versus Shock Wave Lithotripsy for Renal Stones Smaller Than 2 cm: A Randomized Clinical Trial. Urol J. 2016; 13: 2823-2828.
Kilicarslan H, Kaynak Y, Kordan Y, et al. Unfavorable anatomical factors influencing the success of retrograde intrarenal surgery
for lower pole renal calculi. Urol J. 2015; 12:2065-2068.
Zhong W, Leto G, Wang L, Zeng G. Systemic inflammatory response syndrome after flexible ureteroscopic lithotripsy: a study of risk factors. J Endourol. 2015; 29: 25-28.
Yusuke Uchida, Ryoji Takazawa, Sachi Kitayama, Toshihiko Tsujii. Predictive risk factors for systemic inflammatory response syndrome following ureteroscopic laser lithotripsy. Urolithiasis. 2017; Jul 10. doi:
1007/s00240-017-1000-3. [Epub ahead of print].
Blackmur JP, Maitra NU, Marri RR, Housami F, Malki M, McIhenny C. Analysis of Factors' Association with Risk of Postoperative Urosepsis in Patients Undergoing Ureteroscopy for Treatment of Stone Disease. J Endourol. 2016; 30: 963-969.
Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrug-resistant, extensively drugresistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance.
Clin Microbiol Infect. 2012; 18: 268-281.
Fernbach SK, Maizels M, Conway JJ. Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatr Radiol. 1993; 23:478-480.
Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003; 31: 1250-1256.
Zowawi HM, Harris PN, Roberts MJ, et al. The emerging threat of multidrug-resistant Gram-negative bacteria in urology. Nat Rev Urol. 2015; 12: 570-584.
Patel N, Shi W, Liss M, et al. Multidrug resistant bacteriuria before percutaneous nephrolithotomy predicts for postoperative infectious complications. J Endourol. 2015; 29: 531-536.
Margel D, Ehrlich Y, Brown N, Lask D, Livne PM, Lifshitz DA. Clinical implication of routine stone culture in percutaneous nephrolithotomy--a prospective study. Urology. 2006; 67: 26-29.
Martov A, Gravas S, Etemadian M, et al. Postoperative infection rates in patients with a negative baseline urine culture undergoing ureteroscopic stone removal: a matched casecontrol analysis on antibiotic prophylaxis from the CROES URS global study. J Endourol. 2015; 29: 171-180.
Korets R, Graversen JA, Kates M, Mues AC, Gupta M. Post-percutaneous nephrolithotomy systemic inflammatory response: a prospective analysis of preoperative urine, renal pelvic urine and stone cultures. J Urol. 2011; 186: 1899-1903.
Gutierrez J, Smith A, Geavlete P, et al. Urinary tract infections and post-operative fever in percutaneous nephrolithotomy. World J Urol. 2013; 31: 1135-1140.
Linden P. Safety profile of meropenem: an updated review of over 6,000 patients treated with meropenem. Drug Saf. 2007; 30: 657-668.
Peloquin CA, Berning SE, Nitta AT, et al. Aminoglycoside toxicity: daily versus thriceweekly dosing for treatment of mycobacterial diseases. Clin Infect Dis. 2004; 38: 1538-1544.
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