A prospective Comparative Clinical Study on Bladder Urine, Pelvic Urine and Renal Stone Culture & Sensitivity in Predicting Urosepsis Following Percutaneous Nephrolithotomy

Urosepsis Following Percutaneous Nephrolithotomy

Keywords: Percutaneous nephrolithotomy, Urosepsis


Background: Urosepsis means a severe infection of urinary tract (UTI) and/or male genital tract (prostate) with features consistent with systemic inflammatory response syndrome. UTI may occur among all the age groups and produce a broad range of clinical syndromes ranging from asymptomatic bacteriuria to acute pyelonephritis with gram negative sepsis to septic shock. It is estimated that the mortality rate due to urosepsis ranges from 30 to 40 p.c respectively. Urosepsis may also cause multiple organ dysfunction, hypoperfusion or hypotension. Urosepsis due to percutaneous nephrolithotomy may be catastrophic despite prophylactic antibiotic coverage and negative midstream urine culture and sensitivity testing (C&S) and bacteria in the stone can be responsible for systemic infection. The aim of the study is to compare bladder urine (culture      & sensitivity) and collecting system urine and stone (culture and sensitivity) in predicting urosepsis following percutaneous nephrolithotomy. Subjects and Methods: A hospital-based, analytical prospective clinical study was conducted among thirty cases who were present during   the study period and had undergone percutaneous nephrolithotomy (PCNL). Cases were included irrespective of gender with renal calculi       in whom percutaneous nephrolithotomy was about to be done at Narayana Medical College & Hospital, Chintareddypalem, Nellore, Andhra Pradesh during 1st February 2014 to 31st January 2015. Data collected was divided into three main groups Midstream urine (C&S); Pelvic urine (C&S); and Stone (C&S) respectively. Data obtained was entered in Microsoft Excel-2013 and analyzed in SPSS version-22 trial. Appropriate statistical tests were applied and p-value less than 0.05 was considered as significant. Results: Bladder urine (C&S) was positive in 3/30 (10.00%) patients, Pelvic urine (C&S) in 5/30 (16.66 %) patients and Stone (C&S) in 8/30 (26.66 %) patients. Most of the infected specimens grew Escherichia coli followed by pseudomonas, klebsiella, enterococcus. Systemic Inflammatory Response Syndrome (SIRS) was reported among 26.7 p.c (8) of the patients. In one patient (3.33%) septic shock developed but no deaths were reported. Conclusion: Stone (C&S) and Pelvic urine (C&S) are better predictors of urosepsis than Bladder urine (C&S).


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Kalra OP, Raizada A. Management issues in urinary tract infections. J Gen Med. 2006;18:16–22.

Kalra OP, Raizada A. Approach to a patient with urosepsis. J Global Inf Dis. 2009;1(1):57–61.

Hotchkiss RS, Karl IE. The Pathophysiology and Treatment of Sepsis. New England J Med. 2003;348(2):138–150. Available from: https://dx.doi.org/10.1056/nejmra021333.

Gastmeier P, Kampf G, Wischnewski N, Hauer T, Schulgen G, Schumacher M, et al. Prevalence of nosocomial infec- tions in representative German hospitals. J Hospital Inf. 1998;38(1):37–49. Available from: https://dx.doi.org/10.1016/s0195-6701(98)90173-6.

Thornton HV, Hammond A, Hay AD. Urosepsis: a growing and preventable problem? Br J Gen Practice. 2018;68(675):493–494. Available from: https://dx.doi.org/10.3399/bjgp18x699317.

Wickham JEA, Miller RA, Kellet MJ, Payne SR. Percu- taneous Nephrolithotomy: One Stage or Two? Br J Urol. 1984;56(6):582–585. Available from: https://dx.doi.org/10.1111/j.1464-410x.1984.tb06121.x.

Charton M, Vallancien G, Veillon B, Brisset JM. Urinary Tract Infection in Percutaneous Surgery for Renal Calculi. J Urol. 1986;135(1):15–17. Available from: https://dx.doi.org/10.1016/s0022-5347(17)45500-5.

Paterson RF, Kuo RL, Lingeman JE. Staghorn calculus endo- toxin expression in sepsis. Urol. 2003;62(1):197–197. Avail- able from: https://dx.doi.org/10.1016/s0090-4295(02)02132-5.

Scherz HC, Parsons CL. Prophylactic antibiotics in urology. Urol Clin North Am. 1987;14(2):265–271.

Areda MA, Bailey CR, O’Mara D, Weiss CR. Transplant uretero-inguinal hernia resulting in urosepsis. Radiol Case Rep. 2018;14(1):14–17. Available from: https://pubmed.ncbi.nlm.nih.gov/30305858/.

Vikrant S, Gupta D, Singh M. Epidemiology and outcome of acute kidney injury from a tertiary care hospital in India. Saudi Journal of Kidney Diseases and Transplantation. 2018;29(4):956–956. Available from: https://dx.doi.org/10.4103/1319-2442.239633.

Kalra OP, Raizada A. Approach to a patient with urosepsis. J Glob Infect Dis. 2009;1(1):57–63.

Fowler JE. Bacteriology of Branched Renal Calculi and Accompanying Urinary Tract Infection. J Urol. 1984;131(2):213–215. Available from: https://dx.doi.org/10.1016/s0022-5347(17)50311-0.

Bratell S, Brorson JE, Grenabo L, Hedelin H, Pettersson S. The Bacteriology of Operated Renal Stones. Eur Urol. 1990;17(1):58–61. Available from: https://dx.doi.org/10.1159/000464001.

McCartney AC, Clark J, Lewi HJE. Bacteriological study of renal calculi. Eur J Clin Microbiol. 1985;4(6):553–555. Available from: https://dx.doi.org/10.1007/bf02013393.

Cadeddu JA, Chen R, Bishoff J, Micali S, Kumar A, Moore RG, et al. Clinical Significance of Fever After Percutaneous Nephrolithotomy. Urol. 1998;52(1):48–50. Available from: https://dx.doi.org/10.1016/s0090-4295(98)00146-0.

Rao PN, Dube DA, Weightman NC, Oppenheim BA, Morris J. Prediction of Septicemia Following Endourological Manipulation for Stones in the Upper Urinary Tract. J Urol. 1991;146(4):955–960. Available from: https://dx.doi.org/10.1016/s0022-5347(17)37974-0.