Heterogeneity in stone culture protocols and endourologist practice patterns: a multi-institutional survey.

Kidney stone cultures can be beneficial in identifying bacteria not detected in urine, yet how stone cultures are performed among endourologists, under what conditions, and by what laboratory methods remain largely unknown. Stone cultures are not addressed by current clinical guidelines. A comprehensive REDCap electronic survey sought responses from directed (n = 20) and listserv elicited (n = 108) endourologists specializing in kidney stone disease. Questions included which clinical scenarios prompt a stone culture order, how results influence post-operative antibiotics, and what microbiology lab protocols exist at each institution with respect to processing and resulting stone cultures. Logistic regression statistical analysis determined what factors were associated with performing stone cultures. Of 128 unique responses, 11% identified as female and the mean years of practicing was 16 (range 1-46). A specific 'stone culture' order was available to only 50% (64/128) of those surveyed, while 32% (41/128) reported culturing stone by placing a urine culture order. The duration of antibiotics given for a positive stone culture varied, with 4-7 days (46%) and 8-14 days (21%) the most reported. More years in practice was associated with fewer stone cultures ordered, while higher annual volume of percutaneous nephrolithotomy was associated with ordering more stone cultures (p < 0.01). Endourologists have differing practice patterns with respect to ordering stone cultures and utilizing the results to guide post-operative antibiotics. With inconsistent microbiology lab stone culture protocols across multiple institutions, more uniform processing is needed for future studies to assess the clinical benefit of stone cultures and direct future guidelines.

Urolithiasis. 2022 Dec 12*** epublish ***

David T Tzou, Karen L Stern, Brian D Duty, Ryan S Hsi, Noah E Canvasser, Smita De, Ava C Wong, Charis R Royal, Meleighe L Sloss, Justin B Ziemba, Jonathan D Harper, Seth K Bechis, Anna M Zampini, Michael S Borofsky, John Roger Bell, Justin I Friedlander, David A Leavitt, Amihay Nevo, Nishant D Patel, Roshan M Patel, Zeph Okeke, Marcelino E Rivera, Chiu-Hsieh Hsu, Thomas Chi, Gayatri Vedantam, William D Lainhart

Department of Urology, University of Arizona College of Medicine, 1501 N. Campbell Ave, PO Box 245077, Tucson, AZ, 85724, USA. ., Department of Urology, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA., Department of Urology, Oregon Health and Science University, 3303 SW Bond Ave, CH10U, Portland, OR, 97239, USA., Department of Urology, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville, TN, 37232, USA., Department of Urology, University of California Davis, 4860 Y Street, Suite 3500, Sacramento, CA, 95817, USA., Department of Urology, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA., Department of Urology, University of Arizona College of Medicine, 1501 N. Campbell Ave, PO Box 245077, Tucson, AZ, 85724, USA., Division of Urology, University of Pennsylvania, 3PCAM West, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA., Department of Urology, University of Washington, 1959 NE Pacifica St, Seattle, WA, 98195, USA., Department of Urology, University of California San Diego, 200 W. Arbor Drive #8897, San Diego, CA, 92103, USA., Department of Urology, University of Minnesota, 420 Delaware St SE, Box 394 Mayo, Minneapolis, MN, 55455, USA., Department of Urology, University of Kentucky, MS 277 Medical Science Bldg., Lexington, KY, 40536, USA., Temple Health/Fox Chase Cancer Center, 2705 Dekalb Pike, Medical Arts Pavilion, Suite 310, East Norriton, PA, 19041, USA., Vattikui Urology Institute, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA., Department of Urology, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA., Department of Urology, University of Virginia, 500 Ray C. Hunt Drive, Charlottesville, VA, 22903, USA., Department of Urology, University of California, Irvine. 333 City Blvd. West, Suite 2100, Orange, CA, 92868, USA., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 450 Lakeville Road, Suite M41, Lake Success, NY, 11042, USA., Indiana University, Methodist Prof Bldg MPC1 220. 1801 N. Senate Blvd, Indianapolis, IN, 46202, USA., College of Public Health, University of Arizona, Roy P. Drachman Hall, Rm. A232, Tucson, AZ, 85721, USA., Department of Urology, University of California San Francisco, 400 Parnassus Ave, San Francisco, CA, 94122, USA., College of Animal Sciences, University of Arizona. Animal and Comparative Bio Sci, Rm 227, Tucson, AZ, 85721, USA., Departments of Pathology and Medicine, University of Arizona College of Medicine, 1501 N. Campbell Ave, Tucson, AZ, 85724, USA.