Category: New Technology: Infection

MP22-1 - Clinical relevance of the bacteria spread into the irrigation fluid during endourological procedures: a novel tool to guide appropriate postoperative antibiotic management?

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective :

The risk of infections after endourological procedures for lithiasis is associated with positive stone cultures (SC). The presence of bacteria colonizing stones and the release of endotoxins during fragmentation may be the explanation. We assess the correlation between urine culture during stone fragmentation (SFUC), bladder culture (BUC), renal pelvic culture (RPUC) and SC; and their association with the risk of systemic inflammatory response syndrome (SIRS).


Methods :

The study included 71 consecutive patients who underwent percutaneous nephrolithotomy (PCNL, n= 43) or retrograde intrarenal surgery (RIRS, n= 28) from January 2017 to September 2017. Patients underwent a preoperative BUC. Samples for RPUC were obtained by renal catheterization. Stone fragments and irrigation fluid sample during fragmentation were sent for culture. We analysed concordance between cultures and association with SIRS.


Results : Overall, mean (SD) age was 54.1 (15.1) years and mean stone size was 15.7 (7.4) mm. Thirteen patients (18.3%) had positive BUC and received specific antibiotic treatment prior to surgery. Tab.1 shows distribution of positive cultures. Concordance between SFUC and SC species was found in 14/15 (93.3%) cases. The most frequently agents were E. faecalis and E.coli. SFUC predicts positive SC with 78.9% sensitivity, 98.1% specificity and a positive predictive value (PPV) of 93.8%. SFUC predicts the organism in SC with 82.4% sensitivity, 96.3% specificity with a PPV of 87.5%. SIRS occurred in 13 (18.3%) patients, sepsis in 3 (4.2%). All blood cultures revealed the same agent found in SC and SFUC. Patients who developed SIRS had a higher rate of positive SFUC (p=0.03) and SC (p=0.015) than those without SIRS, but this was not the case for BUC and RPUC.


Conclusions : The bacteria spread into the irrigation fluid is clinically relevant because it has high microbiological concordance with SC and is associated with higher risk of SIRS than patients with positive BUC and RPUC. This novel tool could be used to guide appropriate postoperative antibiotic treatment when a SC could not be obtained (e.g. small calculi or complete dusting).

Elisa De Lorenzis

Resident
Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Luca Boeri

Resident
Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milano, Lombardia, Italy

Luca Boeri MD, Resident in Urology, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
I am a III year resident in Urology (chief Prof. Emanuele Montanari). I have been doing research since 4 years. My interests are in minimally invasive surgery, endourology, stone disease, infections, prostate cancer, bladder cancer and andrology.
I am currently attending a 1 year Research Fellowship at Mayo Clinic (Rochester, Minnesota, USA).
Our Department in Milan is a leading center for PCNL, RIRS, UTUC treatment, robotic surgery.

Andrea Gallioli

Resident
Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Matteo Fontana

Resident
Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Stefano Paolo Zanetti

Resident
Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Franco Palmisano

Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Stefano Luzzago

Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Gianluca Sampogna

Resident
Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Fabrizio Longo

Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Rosaria Colombo

IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Microbiology and Virology , Milan, Italy
Milan, Lombardia, Italy

Milena Arghittu

IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Microbiology and Virology , Milan, Italy
Milan, Lombardia, Italy

Stefania Piconi

ASST Fatebenefratelli Sacco, 1st Division of Infectious Diseases, Milan, Italy
Milan, Lombardia, Italy

Andrea Salonia

IRCCS Ospedale San Raffaele, URI, Division of Experimental Oncology/Unit of Urology; URI; Milan, Italy
Milan, Lombardia, Italy

Giancarlo Albo

Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy

Emanuele Montanari

Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Urology, Milan, Italy
Milan, Lombardia, Italy