Category: Clinical Stones: PCNL
Introduction & Objective :
Percutaneous nephrolithotomy (PCNL) is standard treatment for renal calculi >2cm and staghorn calculi. Post-operative pyrexia and sepsis are the most common complications despite prophylactic antibiotics. Urinary tract infection is a contraindication to the procedureand urine cultures should be checked and treated prior to surgery, however, with infection stones it may be impossible to clear the urinary tract of infection without managing the offending stone. These patients are at high risk of postoperative infective complications.
This study aimed to assess if intraoperative stone cultures or postoperative blood cultures were more beneficial in guiding antibiotic therapy for patients suffering these complications.
A retrospective audit of prospectively collected data was gathered from review of clinical and operative notes from patients undergoing percutaneous nephrolithotomy by a single surgeon between September 2012 and November 2016. Patient demographics, preoperative blood biochemistry, midstream specimen of urine (MSSU), operative factors, lithiasis factors and post-operative sepsis, blood cultures and stone cultures were recorded.
There were 181 PCNL procedures performed with equal sex ratio and mean stone size of 31.5mm in maximal length (SD 16.3mm). Postoperatively 32 patients (17.7%) suffered post-operative pyrexia, systemic inflammatory response or sepsis. 56 patients had a positive MSSU preoperatively. 100% of patients with postoperative infective complications had a positive MSSU, which were treated pre-operatively.
Blood cultures were performed in 22 patients (79%) and stone cultures were performed in 29 patients (91%). Stone cultures were positive in 83% of patients with postoperative pyrexia or sepsis, compared to 23% positivity in blood cultures in this patient group, X2=18.4, p=<0.001.
Only 6/32 patients (19%) had both blood and stone cultures positive.
In patients with multiple previous antibiotic exposure and urine colonisation we have to ensure prompt, effective antimicrobial management is instituted. In this series blood cultures have poor positive culture yield and we would advocate the use of stone culture to guide antimicrobial treatment in any complicating sepsis.
Caroline Bradley– Academic Foundation Year 2, NHS Greater Glasgow and Clyde, Glasgow, Scotland, United Kingdom
Lynne Kerr– ST5, NHS Greater Glasgow and Clyde, Glasgow, Scotland, United Kingdom
Jane Hendry– Glasgow, Scotland, United Kingdom
Gareth Jones– Glasgow, Scotland, United Kingdom
Academic Foundation Year 2
NHS Greater Glasgow and Clyde
Glasgow, Scotland, United Kingdom
Dr Caroline Bradley, MBChB BMedSci (Hons)
Academic Foundation Year 2, NHS Greater Glasgow and Clyde
Currently working at the Beatson West of Scotland Cancer Centre