Category: Clinical Stones: Outcomes
Introduction & Objective : Funguria is encountered in 1-5% of cultured urine specimens and may be a result of specimen contamination, colonization, or invasive infection. The characteristics and outcomes of patients with funguria undergoing endourologic intervention have not been evaluated.
Methods : A retrospective review was performed to identify patients who had undergone ureteroscopy or percutaneous nephrolithotomy (PCNL) with pre-operative funguria, defined as a urine culture containing >10,000 colony forming units of fungus within 30 days of the operation. Patient demographics, comorbidities, and operative characteristics were recorded. Assessed outcomes included rates of post-operative systemic inflammatory response syndrome (SIRS), ICU admission, length of stay, and readmission.
Results : 65 patients with preoperative funguria were identified, 49 (75.4%) who underwent ureteroscopy and 16 (24.6%) who underwent PCNL. 32 patients’ (49.6%) cultures grew Candida albicans, 17 (26.2%) grew Candida glabrata, and 16 (24.6%) grew Candida, species not specified. 43 patients (66.2%) were female, average age was 55.1±18.3 years, BMI was 31.8±11.0, and Charlson Comorbidity Index was 2.52±2.0. 23 patients (35.4%) carried a diagnosis of neurogenic bladder, of whom 16 had an indwelling urethral or suprapubic catheter, 2 intermittently catheterized, and 2 had a urinary diversion. 57 patients (87.7%) had been exposed to antibiotics in the 3 months prior to intervention. 42 patients (64.6%) received antifungal treatment, of whom 8 received one peri-operative dose while 34 received a full course of treatment. 18 (29.2%) patients met SIRS criteria post-operatively and 11 (16.9%) required ICU admission. 3 (4.6%) and 2 (3.1%) patients developed post-operative fungemia and bacteremia, respectively. All cases of fungemia were due to C. glabrata. Of 29 stone cultures performed, 25 (86.2%) grew Candida species. 19 patients (29.2%) were readmitted and no patients died within 30 days. On univariable analysis, presence of an indwelling catheter (p=0.009), a known neurological diagnosis (p=0.02), or C. glabrata on preoperative culture (p=0.04), and longer operative time (p=0.04) were predictive of developing post-operative SIRS. No significant predictors were identified on multivariable analysis. Notably, anti-fungal treatment or lack therof was not associated with post-operative SIRS.
Conclusions : Patients with pre-operative funguria have high rates of comorbid illness, urinary catheterization, and recent exposure to antibiotics. This patient population is at high risk of peri-operative infectious complications after endourologic intervention.
Todd Yecies– Resident , UPMC, UPMC, Pittsburgh, Pennsylvania
Anand Mohapatra– Resident Physician, Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
Mohamed Yassin– pittsburgh, Pennsylvania
Michelle Semins– Endourology Faculty, UPMC, Pittsburgh, Pennsylvania
Dr. Todd Yecies is a resident physician at UPMC. He is originally from the Bay Area in California. His research interests include assessment and management of the risks of ionizing radiation in urology and cost-effectiveness in the field of endourology.
Department of Urology, University of Pittsburgh