To determine the ability of urine culture (UC) to predict stent culture (SC) status and associated infectious pathogens, and evaluate the association between SC and post-ureteroscopy sepsis.
We queried our institutions prospectively collected database and identified all patients undergoing ureteroscopy between October 2010 and August 2016 who had a ureteral stent before the operation, and from whom UC and SC were obtained. The study endpoint was post-ureteroscopy sepsis within 48 hours of the procedure. We compared findings in UC and SC, and performed univariate and multivariate analyses to identify predictors of post-ureteroscopy sepsis.
The study group comprised 509 patients at a median age of 56 years; 147 patients (28.9%) were females. Positive UC were found in 91 patients (17.8%) and positive SC in 104 patients (20.4%). Fourty-eight patients (9.4%) had both positive UC and SC, but only 24/48 had identical bacteria in both cultures. The most common pathogens isolated from UC and SC were E. Coli (38.5%) and Enterococcus (18.4%), respectively. Sepsis occurred in 25 patients (4.9%), 21 of which (84%) had positive SC and 14 (59%) had positive UC. On multivariate analysis, female gender and positive SC were significantly associated with post-ureteroscopy sepsis.
Only half of the patients with ureteral stents prior to ureteroscopy and a positive SC and UC have similar pathogens in both cultures. Female gender and positive SC were associated with a higher risk of post-ureteroscopy sepsis in this population. SC may direct the proper antibiotic treatment for septic patients after URS.
The Journal of urology. 2017 Jan 26 [Epub ahead of print]
Amihay Nevo, Roy Mano, Eran Schreter, David A Lifshitz
Unit of Endourology, Rabin Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: ., Unit of Endourology, Rabin Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.