A Feasibility of Percutaneous Nephrolithotomy in Positive Urine Culture: A Single Center Retrospective Study
5 January 2019
Purpose: To determine the efficacy and safety of PCNL in patients with positive urine culture without an any other risk factors prior to surgery, and to define an optimal pre-operative antibiotic regimen for these patients.
Materials and methods: The study included 269 consecutive PCNL cases. These cases were divided into 2 groups according pre-operative urine culture results: sterile (group 1, n=166) and positive (group 2, n=103). Patients with risk factors linked to infection complications were excluded from study. All patients underwent PCNL in the prone position. In group 1, the antibiotic regimen included parenteral injection 30 minutes prior to operation and for 3 days after surgery. Group 2 was given antibiotics 24 hours before PCNL as well as 30 minutes before PCNL and then for 3 days following surgery. On the first day after the operation low dose CT and common blood count were performed on all patients to determine residuals, hematomas, blood loss, and inflammatory markers.
Results: Mean age, stone size, failed ESWL, and prior nephrostomy tube insertion were higher in group 2. Although rate of pre-stented patients was equal in groups. No significant differences were observed between group 1 and 2 in regard to operative time (74,3±26,9 vs 70,2±26,5 min, P=.52), length of stay (3,9±1,2 vs 3,8±1,6 days, P=.24), SIRS (6,0% vs 7,8% patients, P=.07), and leukocyte levels exceeding 10*10*9 (77 (46,4%) vs 49 (47,6%) P=.11). Moreover, there was no sepsis or hemotransfusion in either group. Stone-free rates were also similar (78,9% vs 77,7%, P=.35).
Conclusion: 24-hours continuous antibiotic administration before the operation (paying respect to specific resistance bacterial features) can be considered as alternative to 1-week treatment and allow to perform PCNL with sufficient safety in selected patients. Infected urine is not an independent risk factor of post-operative infections complications after PCNL in low risk patients with kidney stones.
- urine culture
- urinary tract infection
Jayram G, Matlaga BR. Contemporary practice patterns associated with percutaneous nephrolithotomy among certifying urologists. J Endourol. 2014; 28(11):1304-1307.
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.
Patel SR, Nakada SY. The modern history and evolution of percutaneous nephrolithotomy. J Endourol. 2015; 29(2):153-157.
C. Türk, A. Neisius, A. Petrik, et al. EAU Guidelines on urolithiasis 2019. Available from: http://uroweb.org/guideline/urolithiasis/
Moses R, Agarwal D, Raffin E, et al. Post PCNL SIRS is not associated with unplanned readmission. Urology. 2017; 100: 33-37.
Assimos D, Krambeck A, Miller NL et al. Surgical Management of Stones: American Urological Association/Endourological Society Guideline. J. Urol. 2016; 196:1153-1160.
Daniel A. Wollin, Adrian D. Joyce, Mantu Gupta, et al. Antibiotic use and the prevention and management of infectious complications in stone disease. World J Urol. 2017; 35(9):1369-1379.
Mariappan P, Smith G, Moussa SA, et al. One week of ciprofloxacin before percutaneous nephrolithotomy significantly reduces upper tract infection and urosepsis: a prospective controlled study. BJU Int. 2006; 98(5):1075–1079.
Bag S, Kumar S, Taneja N, et al. One week of nitrofurantoin before percutaneous nephrolithotomy significantly reduces upper tract infection and urosepsis: a prospective controlled study. Urology. 2011; 77(1):45–49.
Skolarikos A, de la Rosette J. Prevention and treatment of complications following percutaneous nephrolithotomy. Curr Opin Urol. 2008; 18(2):229–234.
Gonen M, Turan H, Ozturk B, et al. Factors affecting fever following percutaneous nephrolithotomy: a prospective clinical study. J Endourol. 2008; 22(9):2135–2138.
Lai WS, Assimos D. The role of antibiotic prophylaxis in percutaneous nephrolithotomy. Rev. Urol. 2016; 18:10–4.
Joseph KM Li, Jeremy YC Teoh, Chi-Fai Ng. Updates in endourological management of urolithiasis. Int J Urol. 2018; 25(9):1-12.
Ibrahim A, Wollin D, Preminger G, et al. Technique of Percutaneous Nephrolithotomy. J Endourol. 2018; 32, suppl 1.
Etemadian M, Haghighi R, Madianeay A, et al. Delayed Versus Same-Day Percutaneous Nephrolithotomy in Patients With Aspirated Cloudy Urine. Urol J. 2008; 5:28-33.
Hosseini MM, Basiri A, Moghaddam H. Percutaneous Nephrolithotomy of Patients with Staghorn Stone and Incidental Purulent Fluid Suggestive of Infection. J Endourol. 2007; 21(12):1429-1432.
Sharma K, Narayan S, Goel A, et al. Factors predicting infectious complications following percutaneous nephrolithotomy Urology Annals. 2016; 8(4):434-438.
Dogan HS, Sahin A, Cetinkaya Y, et al. Antibiotic prophylaxis in percutaneous nephrolithot- omy: prospective study in 81 patients. J Endourol. 2002; 16(9):649–653.
Gravas S, Montanari E, Geavlete P, et al. Postoperative infection rates in low risk patients undergoing percutaneous nephrolithotomy with and without antibiotic prophylaxis: a matched case control study. J Urol. 2012; 188(3):843–847.
Demirtas A, Yildirim YE, Sofikerim M, et al. Comparison of infection and urosepsis rates of ciprofloxacin and ceftriaxone prophylaxis before percutaneous nephrolithotomy: a prospective and randomized study. Sci World J. 2012; 9:1-6.
Bonkat G, Wagenlehner F. In the Line of Fire: Should Urologists Stop Prescribing Fluoroquinolones as Default? Eur Urol. 2018; Available at: https://doi.org/10.1016/j.eururo.2018.10.057.
Fowler JE Jr. Bacteriology of branched renal calculi and accompanying urinary tract infection. J Urol. 1984; 131:213–215.
McAleer I, Kaplan GW, Bradley JS. Endotoxin content in the renal calculi. J Urol. 2003; 169:1813–1814.
Mariappan P, Tolley D. Endoscopic stone surgery: minimizing the risk of post-operative sepsis. Curr Op Urol. 2005; 15:101–105.
Li L, Shen Z, Wang H, Fu S, Cheng G. Investigation of infection risk and the value of urine endotoxin during ESWL. Chin Med J (Engl). 2001;114(5):510-513.
Moses RA, Agarwal D, Raffin EP, et al. Postpercutaneous Nephrolithotomy Systemic Inflammatory Response Syndrome Is Not Associated With Unplanned Readmission. Urology. 2017; 100:33–37.
Bozkurt IH, Aydogdu O, Yonguc T, et al. Predictive Value of Leukocytosis for Infectious Complications After Percutaneous Nephrolithotomy. Urology. 2015; 86(1):25-29.
Korets R, Graversen JA, Kates M, et al. Post-percutaneous nephrolithotomy systemic inflammatory response: a prospective analysis of preoperative urine, renal pelvic urine and stone cultures. J Urol. 2011; 186(5):1899–1903.
- Abstract Viewed: 309 times
- Just Accepted/5561 Downloaded: 124 times