Renal stone culture and sensitivity is a better predictor of potential urosepsis than pelvic or midstream urine culture and sensitivity

Abstract

Background and Aim: Septicemia is a serious complication following percutaneous nephrolithotomy (PCNL) and can occur in spite of sterile preoperative urine culture and prophylactic antibiotics. The aim of the study was to analyze the utility of cultures of midstream urine (MSU), renal pelvic urine, and crushed stones for prediction of urosepsis. Materials and Methods: We performed a prospective clinical study in consecutive patients undergoing PCNL between April 2015 and October 2015. The samples collected for culture and sensitivity (C and S) were (1) MSU one day before surgery, (2) Urine from pelvicaliceal system during percutaneous puncture, and (3) Stone fragments collected during the procedure. All the patients were monitored during the postoperative period for symptoms and signs of urosepsis. The data collected were divided into 3 main groups, i.e., MSU C and S, pelvic urine C and S, and stone C and S, and were analyzed to determine association with urosepsis. Results: A total of 83 patients were included. The MSU C and S was positive in 10.8%, pelvic C and S in 13.7%, and stone C and S in 30.1% patients. Twenty patients had systemic inflammatory response syndrome (SIRS) and 3 patients had septic shock. Out of the 20 with SIRS, 17 cases were stone C and S positive, 6 were pelvic urine C and S positive, and 2 patients had positive MSU C and S. Conclusion: Stone C and S is a better predictor of potential urosepsis than pelvic urine and MSU C and S, which often fail to grow stone colonizing bacteria. We recommend routine collection of stone for C and S for the diagnosis and management of urosepsis after PCNL.

Keywords

• Midstream urine
• pelvic urine
• percutaneous nephrolithotomy
• renal stone culture and sensitivity
• urosepsis