Risk factors for fever and sepsis after percutaneous nephrolithotomy

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Abstract

Objective

Percutaneous nephrolithotomy (PCNL) is commonly used in the management of large renal stones. Postoperative infections are one of the most common complications of this procedure. The present study is to determine and assess the factors that may increase the risk to develop fever and urinary sepsis after PCNL.

Methods

A total of 60 patients (38 males and 22 females) with a mean age of 40.25 years enrolled in this study in Sulaimania Teaching Hospital. Patients had renal stone disease need operation with different socioeconomic status, body mass index and different type and size of stones were included in this study. Patients with preoperative positive urine culture and sensitivity were excluded. Preoperative investigations done for all patients. All Patients received prophylactic antibiotic gentamicin intravenously at the induction of anaesthesia. Renal pelvis urine sample were taken from all patients after puncturing the pelvicalyceal system and send for culture and sensitivity. Patients were monitored closely in the postoperative period for the development of fever and sepsis.

Results

Mean duration of the operations was 77.08 min ranged 40–120 min. All patients had postoperative nephrostomy tube. Seventeen (28.33%) patients developed post PCNL fever and the statistically significant factors for post PCNL fever were diabetes mellitus (DM) ( p = 0.001), stone burden ( p = 0.001), number of the stones ( p < 0.001), degree of hydronephrosis ( p = 0.001), duration of the operation ( p < 0.001), residual stones ( p = 0.001) and number of tracts ( p = 0.038). Three (5.00%) patients developed post PCNL sepsis, and the statistically significant risk factors for post PCNL sepsis were duration of the operation ( p = 0.013) and intraoperative blood loss, postoperative drop in haemoglobin (HB) level ( p = 0.046).

Conclusion

DM, staghorn stones, degree of hydronephrosis, duration of the operation and number of tracts are risk factors for post PCNL fever, while number of stones, intraoperative blood loss, duration of the operation and residual stones are risk factors for post PCNL sepsis.

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Most cited references 18

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Categorisation of complications and validation of the Clavien score for percutaneous nephrolithotomy.

Jean de la Rosette, Dedan Opondo, Francisco Daels … (2012)

Although widely used, the validity and reliability of the Clavien classification of postoperative complications have not been tested in urologic procedures, such as percutaneous nephrolithotomy (PCNL). To validate the Clavien score and categorise complications of PCNL. Data for 528 patients with complications after PCNL were used to create a set of 70 unique complication-management combinations. Clinical case summaries for each complication-management combination were compiled in a survey distributed to 98 urologists, who rated each combination using the Clavien classification. Interrater agreement for Clavien scores was estimated using Fleiss' kappa (κ). The relationship between Clavien score and the duration of postoperative hospital stay was analysed using multivariate nonlinear regression models that adjusted for operating time, preoperative urine microbial culture, presence of staghorn stone, and use of postoperative nephrostomy tube. Overall interrater agreement in grading postoperative complications was moderate (κ=0.457; p<0.001). Agreement was highest for Clavien score 5 and decreased with lower Clavien scores. Higher agreement was found for Clavien scores 3 and 4 than in subcategories of these scores. Postoperative stay increased with higher Clavien scores and was unaffected by inherent differences between study centres. A standard list of post-PCNL complications and their corresponding Clavien scores was created. Although the Clavien classification demonstrates high validity, interrater reliability is low for minor complications. To improve the reliability and consistency of reporting adverse outcomes of PCNL, we have assigned Clavien scores to complications of PCNL. Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.

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Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy: a prospective clinical study.

Paramananthan Mariappan, Gordon Smith, Simon Bariol … (2005)

Urosepsis due to manipulation during percutaneous nephrolithotomy (PCNL) can be catastrophic despite prophylactic antibiotic coverage, and negative midstream urine culture and sensitivity testing (C&S). It has been postulated that bacteria in the stone may be responsible for systemic infection. In this prospective study we determined the correlation between different sites of urine sampling, including stones, and also ascertained which is more predictive of urosepsis. All patients undergoing PCNL who fulfilled our selection criteria were recruited. The samples collected were 1) midstream urine and bladder urine at cystoscopy, 2) renal pelvic urine collected at percutaneous puncture of the pelvicaliceal system and 3) extracted and later fragmented stones. They were sent immediately for C&S. Patients were monitored for systemic inflammatory response syndrome (SIRS). A total of 54 procedures were suitable for analysis. Midstream urine C&S was positive in 11.1% of cases, stone C&S was positive in 35.2% and pelvic C&S was positive in 20.4% (p = 0.009). Pelvic urine C&S predicted infected stones better than bladder urine C&S. Of the patients 37% had SIRS and 3 experienced septic shock. Patients with infected stones or pelvic urine were found to be at a relative risk for urosepsis that was at least 4 times greater (p = 0.0009). Bladder urine did not predict SIRS. Stone C&S had the highest positive predictive value of 0.7. Preoperative hydronephrosis correlated with infected pelvic urine. No patients with urosepsis had positive blood C&S. The results of this study suggest that positive stone C&S and pelvic urine C&S are better predictors of potential urosepsis than bladder urine. Therefore, routine collection of these specimens is recommended.

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Risk factors for sepsis after percutaneous renal stone surgery.

Evgeniy Kreydin, Brian Eisner (2013)

Since its introduction into the endourologist's armamentarium almost 40 years ago, percutaneous nephrolithotomy (PCNL) has become the standard of care for patients with large-volume nephrolithiasis. Postoperative infection is one of the most common complications of the procedure, and postoperative sepsis is one of the most detrimental. A number of factors have been found to increase the risk of postoperative sepsis. These include patient characteristics that are known preoperatively, such as urine culture obtained from the bladder or from the renal pelvis if percutaneous access to the renal pelvis is obtained in advance to the procedure. Neurogenic bladder dysfunction secondary to spinal cord injury and anatomical renal abnormalities, such as pelvicalyceal dilatation, have also been associated with increased incidence of fever and sepsis after the procedure. Several intraoperative factors, such as the average renal pressure sustained during PCNL and the operative time, also seem to increase the risk of sepsis. Finally, the contribution of postoperative factors, such as presence of a nephrostomy tube or a urethral catheter, has also been investigated. A short preoperative course of antibiotics has been found to significantly decrease the rate of postoperative fever and sepsis. Novel agents targeted at sepsis prevention and treatment, such as anti-endotoxin antibodies and cholesterol-lowering drugs statins, are currently under investigation.

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Author and article information

Contributors

Aso Omer Rashid

Journal

Journal ID (nlm-ta): Asian J Urol

Journal ID (iso-abbrev): Asian J Urol

Title: Asian Journal of Urology

Publisher: Second Military Medical University

ISSN (Print): 2214-3882

ISSN (Electronic): 2214-3890

Publication date PMC-release: 11 March 2016

Publication date (Print): April 2016

Publication date (Electronic): 11 March 2016

Volume: 3

Issue: 2

Pages: 82-87

Affiliations

[a ]Department of Surgery, School of Medicine, University of Sulaimani, Sulaimani, Iraq

[b ]Department of Urology, Sulaimani Teaching Hospital, Sulaimani, Iraq

Author notes

[∗ ]Corresponding author. Department of Surgery, School of Medicine, University of Sulaimani, Sulaimani, Iraq.Department of SurgerySchool of MedicineUniversity of SulaimaniSulaimaniIraq asoomer62@ 123456hotmail.com

Article

Publisher ID: S2214-3882(16)30003-0

DOI: 10.1016/j.ajur.2016.03.001

PMC ID: 5730806

PubMed ID: 29264169

SO-VID: e5aad097-5db8-43c8-b3e8-d810b7d298e1

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

History

Date received : 1 December 2015

Date revision received : 19 January 2016

Date accepted : 23 February 2016

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Risk factors for fever and sepsis after percutaneous nephrolithotomy

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Most cited references 18

Categorisation of complications and validation of the Clavien score for percutaneous nephrolithotomy.

Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy: a prospective clinical study.

Risk factors for sepsis after percutaneous renal stone surgery.

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