AUA 2017: Early Discharge Following Decompression For Sepsis and an Obstructing Stone? A Multi-institutional Study to Identify Predictors of Antibiotic Sensitivity

Boston, MA ( Treatment for patients presenting with sepsis due to an obstructing stone requires urgent urinary tract decompression. Following this, patients are hospitalized for hemodynamic support and broad spectrum antibiotics. Urine culture results are used to tailor outpatient antibiotic therapy. At times patients achieve early clinical stability but remain hospitalized while awaiting antibiotic sensitivities. Dr. Tran and his coauthors attempted to identify predictors of antibiotic resistance that may allow clinicians to select candidates for early discharge on empiric oral antibiotics prior to receiving culture results.

Patients analyzed in the study included all patients who underwent emergent urinary tract decompression for sepsis due to an obstructing ureteral stone in the last 2 years at two institutions. A total of 134 patients were identified meeting the inclusion criteria.

84/134 patients (62.7%) had available urine cultures with antibiotic sensitivities. Patients with pan-sensitive and resistant urine cultures were compared. Patients with resistant cultures were more likely to have had previous urologic surgery (44.7% vs. 22.0%, p = 0.008) - especially those who underwent previous ureteroscopy (38.9% vs. 8.0%, p = 0.0002). Patients with resistant cultures were more likely to require postoperative ICU-level care (27.1% vs. 12.0%, p = 0.039), have bacteremia (48.2% vs. 24.0%, p = 0.005) and have a longer hospital stay (5.4 vs. 3.4 days, p = 0.026). Notably, resistance patterns were noted to be similar between both involved institutions.

Dr. Tran concluded that patients who had previous urologic surgery appear to be poor candidates for early discharge with empiric antibiotics prior to receiving urine culture results.

Speaker: Timothy Tran, New York, NY

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA