Clinical characteristics of postoperative febrile urinary tract infections after ureteroscopic lithotripsy

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Abstract

Purpose

Ureteroscopic lithotripsy (URS) is gaining popularity for the management of ureteral stones and even renal stones, with high efficacy and minimal invasiveness. Although this procedure is known to be safe and to have a low complication rate, febrile urinary tract infection (UTI) after URS is not rare. Therefore, we aimed to analyze the risk factors and causative pathogens of febrile UTI after URS.

Materials and Methods

Between January 2013 and June 2015, 304 patients underwent URS for ureteral or renal stones. The rate of postoperative febrile UTI and the causative pathogens were verified, and the risk factors for postoperative febrile UTI were analyzed using logistic regression analysis.

Results

Of 304 patients, postoperative febrile UTI occurred in 43 patients (14.1%). Of them, pathogens were cultured in blood or urine in 19 patients (44.2%), and definite pathogens were not identified in 24 patients (55.8%). In patients with an identified pathogen, Pseudomonas aeruginosa had the highest incidence. Multivariate analysis showed that the operation time (p<0.001) was an independent risk factor for febrile UTI after URS. The cut-off value of operation time for increased risk of febrile UTI was 70 minutes.

Conclusions

Overall, febrile UTI after URS occurred in 14.1% of patients, and the operation time was an independent predictive factor for this complication. Considering that more than 83.7% of febrile UTIs after URS were not controlled with fluoroquinolones, it may be more appropriate to use higher-level antibiotics for treatment, even in cases with unidentified pathogens.

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Most cited references 20

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Best practice policy statement on urologic surgery antimicrobial prophylaxis.

J. Stuart Wolf Jr., Carol Bennett, Roger R. Dmochowski … (2008)

Antimicrobial prophylaxis is the periprocedural systemic administration of an antimicrobial agent intended to reduce the risk of postprocedural local and systemic infections. The AUA convened a BPP Panel to formulate recommendations on the use of antimicrobial prophylaxis during urologic surgery. Recommendations are based on a review of the literature and the Panel members' expert opinions. The potential benefit of antimicrobial prophylaxis is determined by patient factors, procedure factors, and the potential morbidity of infection. Antimicrobial prophylaxis is recommended only when the potential benefit outweighs the risks and anticipated costs (including expense of agent and administration, risk of allergic reactions or other adverse effects, and induction of bacterial resistance). The prophylactic agent should be effective against organisms characteristic of the operative site. Cost, convenience, and safety of the agent also should be considered. The duration of antimicrobial prophylaxis should extend throughout the period when bacterial invasion is facilitated and/or likely to establish an infection. Prophylaxis should begin within 60 minutes of the surgical incision (120 minutes for intravenous fluoroquinolines and vancomycin) and generally should be discontinued within 24 hours. The AHA no longer recommends antimicrobial prophylaxis for genitourinary surgery solely to prevent infectious endocarditis. Justifications and recommendations for specific antimicrobial prophylactic regimens for specific categories of urologic procedures are provided. The recommendations provided in this document, including specific indications and agents enumerated in the Tables, can assist urologists in the appropriate use of periprocedural antimicrobial prophylaxis.

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Clinical Practice Guidelines for the Antibiotic Treatment of Community-Acquired Urinary Tract Infections

Cheol-In Kang, Jieun Kim, Dae Park … (2018)

Urinary tract infections (UTIs) are infectious diseases that commonly occur in communities. Although several international guidelines for the management of UTIs have been available, clinical characteristics, etiology and antimicrobial susceptibility patterns may differ from country to country. This work represents an update of the 2011 Korean guideline for UTIs. The current guideline was developed by the update and adaptation method. This clinical practice guideline provides recommendations for the diagnosis and management of UTIs, including asymptomatic bacteriuria, acute uncomplicated cystitis, acute uncomplicated pyelonephritis, complicated pyelonephritis related to urinary tract obstruction, and acute bacterial prostatitis. This guideline targets community-acquired UTIs occurring among adult patients. Healthcare-associated UTIs, catheter-associated UTIs, and infections in immunocompromised patients were not included in this guideline.

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Complications of 2735 retrograde semirigid ureteroscopy procedures: a single-center experience.

Victor Mirciulescu, G Nita, Petrisor Geavlete … (2006)

Ureteroscopy is nowadays one of the techniques most widely used for upper urinary- tract pathology. Our goal is to describe its complications in a large series of patients. Between June 1994 and February 2005, 2436 patients aged 5 to 87 years underwent retrograde ureteroscopy (2735 procedures) under video and fluoroscopic assistance. We used semirigid ureteroscopes (8/9.8F Wolf, 6.5F Olympus, 8F and 10F Storz) for 384 diagnostic and 2351 therapeutic procedures. Upper urinary-tract lithiasis (2041 cases), ureteropelvic junction stenosis (95 cases), benign ureteral stenosis (29 cases), tumoral extrinsic ureteral stenosis (84 cases), iatrogenic trauma (35 cases), superficial ureteral tumors (16 cases), superficial pelvic tumors (7 cases), and ascending displaced stents (44 cases) were the indications. The mean follow-up period was 56 months (range 4-112 months). The rate of intraoperative incidents was 5.9% (162 cases). Intraoperative incidents consisted of the impossibility of accessing calculi (3.7%), trapped stone extractors (0.7%), equipment damage (0.7%), and double- J stent malpositioning (0.76%). In addition, migration of calculi or stone fragments during lithotripsy was apparent in 116 cases (4.24%). The general rate of intraoperative complications was 3.6% (98 cases). We also saw mucosal injury (abrasion [1.5%] or false passage [1%]), ureteral perforation (0.65%), extraureteral stone migration (0.18%), bleeding (0.1%), and ureteral avulsions (0.11%). Early complications were described in 10.64%: fever or sepsis (1.13%), persistent hematuria (2.04%), renal colic (2.23%), migrated double-J stent (0.66%), and transitory vesicoureteral reflux (4.58%, especially in cases with indwelling double-J stents). We also found late complications such as ureteral stenosis (3 cases) and persistent vesicoureteral reflux (2 cases). Most (87%) of the complications followed ureteroscopic therapy for stones. Three fourths (76%) of the complications occurred in the first 5 years of the series. According to our experience, mastery of ureteroscopic technique allows the urologist to proceed endourologically with minimum morbidity. Despite the new smaller semirigid instruments, this minimally invasive maneuver may sometimes be aggressive, and adequate training is imperative.

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Author and article information

Journal

Journal ID (nlm-ta): Investig Clin Urol

Journal ID (iso-abbrev): Investig Clin Urol

Journal ID (publisher-id): ICU

Title: Investigative and Clinical Urology

Publisher: The Korean Urological Association

ISSN (Print): 2466-0493

ISSN (Electronic): 2466-054X

Publication date (Print): September 2018

Publication date (Electronic): 23 July 2018

Volume: 59

Issue: 5

Pages: 335-341

Affiliations

[1 ]Department of Urology, Kyungpook National University Hospital, Daegu, Korea.

[2 ]Department of Urology, Kyungpook National University Chilgok Hospital, Daegu, Korea.

[3 ]Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea.

Author notes

Corresponding Author: Bum Soo Kim. Department of Urology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea. TEL: +82-53-200-5855, FAX: +82-53-421-9618, urokbs@ 123456knu.ac.kr

Author information

Bum Soo Kim https://orcid.org/0000-0002-4873-3049

Article

DOI: 10.4111/icu.2018.59.5.335

PMC ID: 6121018

PubMed ID: 30182079

SO-VID: cb043433-8a3f-43cb-a666-a5887b31dfe0

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 09 April 2018

Date accepted : 03 July 2018

Funding

Funded by: National Research Foundation of Korea, CrossRef http://dx.doi.org/10.13039/501100003725;

Award ID: NRF-2015R1C1A1A01053009

Award ID: 2016R1C1B1011180

Award ID: NRF-2014M3A9D3034164

Funded by: Ministry of Education, CrossRef http://dx.doi.org/10.13039/501100002701;

Award ID: 2015R1D1A3A03020378

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Clinical characteristics of postoperative febrile urinary tract infections after ureteroscopic lithotripsy

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Abstract

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Most cited references 20

Best practice policy statement on urologic surgery antimicrobial prophylaxis.

Clinical Practice Guidelines for the Antibiotic Treatment of Community-Acquired Urinary Tract Infections

Complications of 2735 retrograde semirigid ureteroscopy procedures: a single-center experience.

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