To investigate which patient, stone, infective and surgical factors were most likely to increase the risk of post-operative urosepsis within 28-days of ureteroscopy and laser stone fragmentation for ureteric or renal stones.
Data were collected prospectively in a single NHS institution. A logistic regression model was used to assess the association of factors with post-operative urosepsis. Two matched-pair analyses were used to assess the risk of post-operative urosepsis in patients with a) an emergency presentation to hospital with urosepsis in the 90 days preceding ureteroscopy and b) a positive mid-stream sample of urine identified, but who were asymptomatic at pre-operative assessment, who then received an appropriate course of antibiotics.
462 consecutive patients were included in the study. 34 patients (7.4%) had an episode of urosepsis within 28-days of their operation. A positive pre-operative MSSU was significantly associated with post-operative urosepsis on multivariable analysis, despite appropriate treatment with a pre-operative course of antibiotics: OR 4.88, 95% CI 2.11-11.31, p<0.001. The presence of diabetes mellitus, ischaemic heart disease, patient ASA score, same-session bilateral ureteroscopy and stone volume were the other variables significantly associated with post-operative infection on univariable analysis, but these ceased to be significantly associated on multivariable analysis. Subgroup analysis found that a positive MSSU in both patients with a pre-operative ureteric stent and those without was significantly associated with post-operative urosepsis, however the odds ratio was much lower for the stented group (OR 3.23 versus OR 16.67). On matched pair analysis, patients with a positive pre-operative MSSU were significantly more likely to have post-operative urosepsis compared to controls (OR 17.46, 95% CI 2.18-139.80,p=0.007). There was no significant difference in odds ratio of post-operative urosepsis in patients who had a preceding urine infection requiring hospital admission in the 90 days preceding ureteroscopy (OR 0.60,95%CI0.19-1.92,p=0.39).
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Journal of endourology / Endourological Society. 2016 Jun 17 [Epub ahead of print]
James Peter Blackmur, Neil U Maitra, Rajendar R Marri, Fadi Housami, Manar Malki, Craig McIlhenny
Urology Department , Forth Valley Royal Hospital , Stirling Road , Larbert, United Kingdom of Great Britain and Northern Ireland , FK5 4WR ; ., Monklands Hospital, 59797, Urology Department, Airdrie, North Lanarkshire, United Kingdom of Great Britain and Northern Ireland ; ., Monklands Hospital, 59797, Urology Department, Airdrie, North Lanarkshire, United Kingdom of Great Britain and Northern Ireland ; ., Western General Hospital, 59892, Urology Department, Edinburgh, Edinburgh, United Kingdom of Great Britain and Northern Ireland ; ., Nottingham University Hospitals NHS Trust, 9820, Nottingham, United Kingdom of Great Britain and Northern Ireland ; ., Forth Valley Royal Hospital, Urology, Glasgow, United Kingdom of Great Britain and Northern Ireland ; .