ACS 2019: The Correlation Between Preoperative Urine Culture and Intraoperative Stone Culture in Patients Undergoing Endoscopic or Percutaneous Management for Urolithiasis

San Francisco, California ( John Barlog, BFA, SUNY Downstate Medical Center, Brooklyn, NY, SUNY Downstate College of Medicine, Brooklyn, NY, assessed the concordance of intraoperative stone and preoperative urine cultures for patients undergoing endoscopic or percutaneous interventions for urolithiasis to identify predictors of positive stone cultures. A retrospective chart review was performed on patients undergoing endoscopic/percutaneous management of renal/ureteral stones from March 2017 to September 2018. Patient characteristics, labs and surgical parameters and Infectious complications were recorded. All patients had preoperative urine cultures and received organism-specific antimicrobial coverage if indicated. Intraoperatively, stones were sent for culture. Correlation of urine culture results and stone culture results were analyzed; logistic regression was performed to identify predictors of positive intraoperative stone cultures.

After identifying a total of 115 consecutive patients that underwent 141 surgical procedures for the treatment of urolithiasis, intraoperative stone cultures were obtained in 71 procedures, with 21(28%) positive cultures. In patients with positive stone cultures, there was a 71% discordance with a preoperative urine culture. 24% of patients with positive stone cultures met SIRS criteria. Predictors of positive stone culture included ASA scores >=3(p=0.02) and positive preoperative urine culture(p<=0.001).

In conclusion, they observed significant discordance between preoperative urine and intraoperative stone cultures. Predictors of positive stone cultures included a positive preoperative urine culture and ASA score >=3. In these patients, intraoperative stone cultures should be routinely obtained. It was interesting to note ASA>3 predictive which suggests these patients more likely to have prior hospitalization and resistant organisms. Limitations include small numbers of patients.

Presented by: John Barlog, MD, BFA, SUNY Downstate Medical Center, Brooklyn, NY, SUNY Downstate College of Medicine, Brooklyn, New York

Written by: Stephen B. Williams, MD, Medical Director for High Value Care; Chief of Urology, Associate Professor, Director of Urologic Oncology, Director Urologic Research, The University of Texas Medical Branch at Galveston, TX at the 2019 American College of Surgeons (ACS), #ACSCC19, October 27–31 in San Francisco, California