OBJECTIVE
To determine whether the duration of antibiotic treatment and timing between urgent
renal decompression and stone intervention impacts the risk of developing urosepsis
following definitive stone treatment.
MATERIALS & METHODS
A retrospective review of patients who were diagnosed with obstructive urolithiasis
and underwent urgent decompression with a ureteral double J stent or percutaneous
nephrostomy at our institution between 2012 and 2018 was performed. We narrowed our analysis to the subset of patients who had suspected infection and
received definitive stone treatment at our institution. Demographic, infection and antimicrobial data, and initial admission to stone treatment
characteristics were collected. Factors associated with developing urosepsis were
analyzed.
RESULTS
We identified 872 patients who were treated with urgent renal decompression, of which
215 were analyzed that had suspected infection and also received definitive stone
removal at our institution. Thirty-three had fevers, 64.2% had a positive urine culture, and 45.6% had urosepsis
at the initial presentation. The median antibiotics duration post decompression was
13 days (IQR 8-18). The median duration from decompression to stone treatment was
17 days (IQR 12-27). Of all, 4.6% of the patients developed urosepsis post ureteroscopy
and 5% post percutaneous nephrolithotomy. No factors were associated with developing
urosepsis post stone treatment on logistic regression analyses.
CONCLUSION
In patients requiring urgent decompression for obstructing urolithiasis and suspected
infection, the time between decompression and stone treatment and the length of antibiotic
exposure did not impact rates of postoperative urosepsis. This highlights the importance
of maintaining high clinical suspicion for prolonged use of antibiotics, to prevent
overtreatment and possible exacerbation of antibiotic resistance.
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References
- Use of percutaneous nephrostomy and ureteral stenting in management of ureteral obstruction.World J Nephrol. 2016; 5: 172
- Impact of the timing of ureteral stent placement on outcomes in patients with obstructing ureteral calculi and presumedinfection.J Endourol. 2019; 33: 736-740
- Evidence-based drainage of infected hydronephrosis secondary to ureteric calculi.J Endourol. 2010; 24: 185-189
- Optimal method of urgent decompression of the collecting system for obstruction and infection due to ureteral calculi.J Urol. 1998; 160: 1260-1264
- Use of drugs for urolithiasis.Clin Cases Mineral Bone Metab. 2008; 5: 131-134
- Management of urinary tract infections associated with urolithiasis.Curr Infect Dis Rep. 2010; 12: 450-454
- The impact of ureteral stent indwelling time on the treatment of acute infection caused by ureteral calculi.Urolithiasis. 2017; 45: 579-583
- Antibacterial resistance worldwide: causes, challenges and responses.Nat Med. 2004; 10: S122-S129
- 2001 sccm/esicm/accp/ats/sis international sepsis definitions conference.Intensive Care Med. 2003; 29: 530-538
- A spectrum of urological emergency reported at a tertiary care teaching hospital: an experience.J Clin Diagn Res: JCDR. 2015; 9: PC12
- Temporal trends, practice patterns, and treatment outcomes for infected upper urinary tract stones in the United States.Eur Urol. 2013; 64: 85-92
- Mortality from kidney stone disease (KSD) as reported in the literature over the last two decades: a systematic review.World J Urol. 2019; 37: 759-776
- Risk factors for urosepsis after ureteroscopy for stone disease: a systematic review with meta-analysis.J Endourol. 2021; 35: 991-1000
- Risk factors for fever and sepsis after percutaneous nephrolithotomy.Asian J Urol. 2016; 3: 82-87
- 1544 risk factors for fever and sepsis after percutaneous nephrolithotomy.J Urol. 2013; 189 (-e633): e633
- Risk factors for sepsis after percutaneous renal stone surgery.Nat Rev Urol. 2013; 10: 598-605
- Factors predisposing to urinary tract infection after J ureteral stent insertion.J Urol. 2002; 167: 1334-1337
- Treatment of the infected stone.Urol Clin. 2015; 42: 459-472
- What have we learned about antimicrobial use and the risks for Clostridium difficile-associated diarrhoea?.J Antimicrob Chemother. 2009; 63: 238-242
- Update on the adverse effects of antimicrobial therapies in community practice.Can Fam Physician. 2020; 66: 651-659
- Clostridium difficile infection risk with important antibiotic classes: an analysis of the FDA adverse event reporting system.Int J Med Sci. 2019; 16: 630
- Oral antibiotic exposure and kidney stone disease.J Am Soc Nephrol. 2018; 29: 1731-1740
- Unnecessary antibiotic prescribing in US ambulatory care settings, 2010–2015.Clin Infect Dis. 2021; 72: 133-137
- Trends in antibiotic resistance of major uropathogens.Matrix Sci Medica. 2020; 4: 108
- Cost of hospitalised patients due to complicated urinary tract infections: a retrospective observational study in countries with high prevalence of multidrug-resistant Gram-negative bacteria: the COMBACTE-MAGNET, RESCUING study.BMJ Open. 2018; 8e020251
- Short vs long-course antibiotic therapy in pyelonephritis: a comparison of systematic reviews and guidelines for the SIMI choosing wisely campaign.Intern Emerg Med. 2021; 16: 313-323
- Duration of antibiotic treatment for acute pyelonephritis and septic urinary tract infection—7 days or less versus longer treatment: systematic review and meta-analysis of randomized controlled trials.J Antimicrob Chemother. 2013; 68: 2183-2191
- Surgical management of stones: American Urological Association/Endourological Society Guideline, part II.J Urol. 2016; 196: 1161
- Urosepsis–etiology, diagnosis, and treatment.Deutsches Arzteblatt Int. 2015; 112: 837-848
- Predictors of urosepsis in struvite stone patients after percutaneous nephrolithotomy.Invest Clin Urol. 2021; 62: 201
Article info
Publication history
Published online: November 02, 2022
Accepted:
October 12,
2022
Received:
June 16,
2022
Footnotes
Declarations of interest: None.
Support/Financial Disclosures: None.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
