Early and rapid prediction for postoperative infections following percutaneous nephrolithotomy in patients with complex kidney stones

To obtain more accurate and rapid predictors for postoperative infections following percutaneous nephrolithotomy (PCNL) in complex kidney stone patients, and provide evidence for early prevention and treatment of postoperative infections.

A total of 802 complex kidney stone patients undergone PCNL from September 2016 to September 2017 were recruited. Urine tests, urine cultures and stone cultures were performed, the perioperative data were prospectively recorded.

19 (2.4%) patients developed postoperative urosepsis. A multivariate logistic regression analysis revealed that operating time ≥100 min, urine tests with both positive urine WBC and positive urine nitrite (WBC+NIT+), positive urine cultures (UC+) and positive stone cultures (SC+) were independent risk factors of urosepsis. The incidence of postoperative urosepsis was higher in the patients with WBC+NIT+ (10%) or the patients with both positive UC and positive SC (UC+SC+; 8.3%) than that in patients with negative urine tests or negative cultures (p<0.01). Preoperative WBC+NIT+ could predict UC+SC+ with accuracy of more than 90%. The main pathogens in kidney stones were Escherichia coli (44%), Proteus mirabilis (14%), Staphylococcus (7.4%), while main pathogens in urine were Escherichia coli (54%), Enterococcus (9.4%) and Proteus mirabilis (7.6%). The occurrence of Escherichia coli was more frequent in the group with urosepsis than in the group without urosepsis (p<0.05).

WBC+NIT+ in preoperative urine tests could be considered as the early and rapid predictor for UC+SC+ and postoperative urosepsis. Urosepsis following PCNL was more related to Escherichia coli infections in complex kidney stone patients. This article is protected by copyright. All rights reserved.

BJU international. 2018 Jul 14 [Epub ahead of print]

Dong Chen, Chonghe Jiang, Xiongfa Liang, Fangling Zhong, Jian Huang, Yongping Lin, Zhijian Zhao, Xiaolu Duan, Guohua Zeng, Wenqi Wu

Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou, 510230, China., Department of Urology, The Sixth Affiliated Hospital of Guangzhou Medical University, The People's Hospital of Qingyuan City, Qingyuan, 511518, China., Department of Laboratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangdong, China.