Category: Clinical Stones: PCNL
Introduction & Objective :
Post-operative infection is common in patients undergoing Percutaneous Nephrolithotomy (PCNL). Calculi are known to act as a focus of infection and bacteriology of extracted stone fragments is routine practice. Positive stone cultures are known to be accurate and are typically available 48-72 hours after incubation.
This study aimed to determine whether stone culture affects clinical practice in the immediate post-operative period.
Patients treated with PCNL from 2013 To 2017 were included in this single surgeon, single centre retrospective review. Case notes were interrogated for study data, antibiotics were recorded at operation and post-operatively.
Results : 96 patients underwent primary PCNL. Mean age was 58 ± 15 years. Infectious complications occurred in 22% . Severity ranged from ranged from isolated fever to septic shock requiring inotropic support. Time to infectious complications was an average of 1 ± 1 days, with stone culture available from an average 3 ± 1 days, this was positive in 45% cases. Antibiotics were started prior to stone culture being available in 100% cases. Organisms were fully sensitive to empirical/pre-operative urine culture based antibiotic therapy in 77% cases. Change in antibiotic therapy in only 1 case was guided in any way by stone culture, in all other cases antibiotics were changed empirically.
Stone cultures were positive infrequently and were only available after antibiotic therapy had been started, limiting their use. Empirical or pre-operative culture based antibiotics were effective in the management of infection. We propose that whilst stone cultures are of some interest they provide little clinical benefit and should not be a routine step in post-operative PCNL care.
Glasgow, Scotland, United Kingdom
Mr. William Maynard MRCSEd MBChB BMedSc, CT2 West of Scotland Deanery, Current hospital Forth Valley Royal Hospital