scholarly journals Percutaneous Nephrolithotomy Can Reduce the Incidence of Sepsis Compared with Flexible Ureteroscopy in Treating Solitary Proximal Ureteral Stone Patients with Positive Urine Culture

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Qi-Dong Xia ◽  
Yu-Feng Wang ◽  
Chen-Qian Liu ◽  
Jin-Zhou Xu ◽  
Jian-Xuan Sun ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Subgroup Analysis ◽  
Ureteral Stone ◽  
Urine Culture ◽  
Flexible Ureteroscopy ◽  
Positive Urine Culture ◽  
Positive Urine ◽  
Proximal Ureteral Stone

Background. Sepsis is a potentially lethal complication for both flexible ureteroscopy (fURS) and percutaneous nephrolithotomy (PCNL). This study is aimed at comparing the sepsis rate after fURS and PCNL and the risk factors for sepsis in patients with solitary proximal ureteral stone. Methods. We reviewed the data of patients with calculi between 10 mm to 20 mm who underwent fURS or PCNL surgery from Tongji Hospital’s database. A total of 910 patients were eligible with 412 fURS cases and 498 PCNL cases. We used univariate analysis and multivariate logistic regression analysis to identify the risk factors for sepsis. Subgroup analysis was performed using logistic regression analysis. Results. In the cohort, 27 (6.6%) and 19 (3.8%) patients developed sepsis after fURS and PCNL, respectively. Multivariate analysis shows that the risk factors for sepsis are fURS ( OR = 3.160 , P = 0.004 ), serum   WBC ≥ 10,000 cells/μL ( OR = 3.490 , P = 0.008 ), albumin − globulin   ratio < 1.2 ( OR = 2.192 , P = 0.029 ), positive urine culture ( OR = 6.145 , P < 0.001 ), and prolonged operation time ( OR = 1.010 , P = 0.046 ). Subgroup analysis was conducted using potential risk factors: stone size, serum WBC, urine culture, and albumin-globulin ratio (AGR). In subgroup of positive urine culture, patients were more likely to develop sepsis after fURS than PCNL. Conclusions. PCNL may be a better choice than fURS to reduce postoperative sepsis, especially for patients with positive urine culture.

scholarly journals Predictive Model for Systemic Infection After Percutaneous Nephrolithotomy and Related Factors Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Yiming Tang ◽  
Chi Zhang ◽  
Chengqiang Mo ◽  
Chengpeng Gui ◽  
Junhang Luo ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Predictive Model ◽  
Urine Culture ◽  
Multivariate Logistic Regression Analysis ◽  
Systemic Infection ◽  
Female Gender ◽  
Positive Urine Culture ◽  
Multivariate Logistic Regression ◽  
Positive Urine

Objectives: To investigate the factors associated with systemic infection after percutaneous nephrolithotomy (PCNL) and establish a predictive model to provide theoretical basis for the prevention of systemic inflammatory response syndrome (SIRS) and urosepsis correlate to percutaneous nephrostomy.Methods: Patients received PCNL between January 2016 and December 2020 were retrospectively enrolled. All patients were categorized into groups according to postoperative SIRS and urosepsis status. Single factor analysis and multivariate logistic regression analysis were performed to determine the predictive factors of SIRS and urosepsis after PCNL. The nomograms were generated using the predictors respectively and the discriminative ability of was assessed by analyses of receiver operating characteristic curves (ROC curves).Results: A total of 758 PCNL patients were enrolled in this study, including 97 (12.8%) patients with SIRS and 42 (5.5%) patients with urosepsis. Multivariate logistic regression analysis suggested that there were 5 factors related to SIRS, followed by preoperative neutrophil to lymphocyte ratio (NLR) (odds ratio, OR = 1.721, 95% confidence interval, CI [1.116–2.653], p = 0.014), S.T.O.N.E. score (OR = 1.902, 95% CI [1.473–2.457], p &lt; 0.001), female gender (OR = 2.545, 95% CI [1.563–4.144], p &lt; 0.001), diabetes history (OR = 1.987, 95% CI [1.051–3.755], p = 0.035), positive urine culture (OR = 3.184, 95% CI [1.697–5.974], p &lt; 0.001). And there were four factors related to urosepsis, followed by preoperative NLR (OR = 1.604, 95% CI [1.135–2.266], p = 0.007), S.T.O.N.E. score (OR = 1.455, 95% CI [1.064–1.988], p = 0.019), female gender (OR = 2.08, 95% CI [1.063–4.07], p = 0.032), positive urine culture (OR = 2.827, 95% CI [1.266–6.313], p = 0.011). A nomogram prediction model was established to calculate the cumulative probability of SIRS and urosepsis after PCNL and displayed favorable fitting by Hosmer–Lemeshow test (p = 0.953, p = 0.872). The area under the ROC curve was 0.784 (SIRS) and 0.772 (urosepsis) respectively.Conclusion: Higher preoperative NLR, higher S.T.O.N.E. score, female gender, and positive urine culture are the most significant predictors of SIRS and urosepsis. Diabetes history is the predictor of SIRS. These data will help identify high-risk individuals and facilitate early detection of SIRS and urosepsis post-PCNL.

scholarly journals A preoperative nomogram for sepsis in percutaneous nephrolithotomy treating solitary, unilateral and proximal ureteral stones

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e9435
Author(s):  
Yang Xun ◽  
Yuanyuan Yang ◽  
Xiao Yu ◽  
Cong Li ◽  
Junlin Lu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Percutaneous Nephrolithotomy ◽  
Urine Culture ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Ureteral Stones ◽  
Positive Urine Culture ◽  
Positive Urine

Background Postoperative sepsis is a lethal complication for percutaneous nephrolithotomy (PCNL). An early predictive model combined local and systemic conditions is urgently needed to predict infectious events. We aim to determine the preoperative predictors of sepsis after PCNL in patients with unilateral, solitary, and proximal ureteral stones. Methods A total of 745 patients who underwent PCNL between January 2012 and December 2018 were retrospectively enrolled. Sepsis was defined based on the International Sepsis Definitions in 2001, and the preoperative factors were compared between the non-sepsis and sepsis groups. Univariable analysis and multivariable logistic regression analysis were conducted to determine the predictors for sepsis after PCNL. A nomogram was generated using the predictors. Results In this study, 35 patients (4.7%) developed sepsis after PCNL. Univariate analysis showed that post-PCNL sepsis was associated with the female, lower albumin, higher globulin, lower albumin globulin ratio (AGR < 1.5), preoperative fever, leukocytosis (WBC ≥ 10,000 cells/μL), positive urine culture, leukocyturia (≥50 cells/μL) and positive urine nitrite. Multivariate logistic regression analysis suggested that AGR < 1.5 (odds ratio [OR] = 5.068, 95% confidence interval [CI] [1.135–22.624], P = 0.033), positive urine culture (OR = 3.243, 95% CI [1.162–9.047], P = 0.025), leukocytosis (OR = 3.706, 95% CI [1.444–9.512], P = 0.006) and female (OR = 2.529, 95% CI [1.127–5.672], P = 0.024) were independent risk factors for sepsis. A nomogram was generated and displayed favorable fitting (Hosmer–Lemeshow test P = 0.797), discrimination (area under receiver operating characteristic curve was 0.807), and clinical usefulness by decision curve analysis. Conclusions Patients with certain preoperative characteristics, such as female, lower AGR, positive urine culture, and leukocytosis, who undergo PCNL may have a higher risk of developing sepsis. A cautious preoperative evaluation and optimized treatment strategy should be considered in these patients to minimize infectious complications.

scholarly journals Risk factors and clinical relevance of positive urine cultures in cats with subcutaneous ureteral bypass

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Julie Deprey ◽  
Arnaud Baldinger ◽  
Véronique Livet ◽  
Margaux Blondel ◽  
Mathieu Taroni ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Condition ◽  
Bacterial Culture ◽  
Urine Culture ◽  
Body Condition Score ◽  
Positive Urine Culture ◽  
Positive Urine ◽  
Condition Score ◽  
Device Placement

Abstract Background The objective of the study was to report the incidence and risk factors associated with positive urine bacterial cultures as well as long-term outcome in cats with subcutaneous ureteral bypass (SUB) devices. Results Medical records of cats that underwent SUB device placement were retrospectively reviewed. Signalment of the cat, laterality of the ureteral obstruction, surgery, anesthesia and hospitalization duration, bacterial culture results and follow-up data were retrieved. Thirty-two cats met the inclusion criteria. Four cats (12.5%) had a positive intraoperative culture, with two of them being treated successfully. Ten cats out of 28 (35.7%) were documented with a positive urine culture during follow-up period, with a median time between discharge and identification of the first positive urine culture of 159 days (range 8–703 days). Bacteriuria resolved in 60% of cats (6/10). Escherichia coli was the most common organism, isolated in 4 out of 10 postoperative urine cultures. Overall, subclinical bacteriura was documented for 6 of 32 (18.8%) cats and 5 of 32 (15.6%) cats displayed clinicals signs suggestive of persistent UTI. One cat had subclinical bacteriuria. Three cats died during the follow-up period. There was a significant difference between negative and positive urine bacterial culture groups in median hospitalization duration (5 days versus 6 days, P = 0.022) and in median body condition score (5/9 versus 4/9, P = 0.03). Cats with a longer hospital stay and with a lower body condition score were more likely to have a positive urine culture during follow-up period. Conclusions SUB device placement surgery is associated with complications such as chronic bacteriuria. Bacteriuria in our study resolved with appropriate antibiotic treatment in more than half of cats. Risk factors identified for positive urine culture were a longer hospitalization duration and a decreased body condition score.

scholarly journals Risk Factors and Significance of Gentamicin Resistant Positive Urine Culture in Patients Undergoing Urological Surgery: A Short Report

2014 ◽  
Vol 8 (4) ◽  
pp. 175-177
Author(s):  
Mazen Alsinnawi ◽  
Sean Egan ◽  
Emma Groarke ◽  
Eddie McCullagh ◽  
Jerome Fennell ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urine Culture ◽  
Short Report ◽  
Positive Urine Culture ◽  
Urological Surgery ◽  
Positive Urine

Risk Factors for a Complicated Postoperative Course in Flexible Ureteroscopy

2021 ◽  
pp. 1-8
Author(s):  
Tomasz Ozimek ◽  
Laura Hochguertel ◽  
Marie C. Hupe ◽  
Julian P. Struck ◽  
Judith R. Wiessmeyer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Antibiotic Prophylaxis ◽  
Urine Culture ◽  
Flexible Ureteroscopy ◽  
Special Focus ◽  
Multivariate Logistic Regression ◽  
Ureteral Access Sheath ◽  
Postoperative Course ◽  
Perioperative Antibiotic Prophylaxis

Introduction: The goal was to determine risk factors for Clavien-Dindo (CD) grade ≥2 complications, with special focus on early postoperative systemic inflammatory response syndrome (SIRS), for flexible ureteroscopy (fURS). Materials and Methods: A retrospective monocentric statistical analysis relating to 32 factors was performed with the χ2 test, Mann-Whitney U tests, and multivariate logistic regression. Results: In total, 416 consecutive fURS performed between September 2013 and June 2017 were analyzed; 283 (68.03%) of these were for stone surgery and 133 (31.97%) for diagnostic purposes. In 43 cases (10.34%), CD ≥2 occurred; 31 cases (72.09%) of these were SIRS. On multivariate logistic regression, positive preoperative urine culture and steep pyelographic and CT-based infundibulopelvic angle (IPA) have been confirmed as independent risk factors for both CD ≥2 and SIRS. Greater maximal median stone diameter and female gender were significantly associated only with a higher CD ≥2 prevalence, but not with SIRS. The influence of ureteral access sheath (UAS) on CD ≥ 2 or SIRS occurrence could not be confirmed on multivariate analysis. Perioperative antibiotic prophylaxis for patients with negative urine culture showed no difference regarding SIRS prevalence. Conclusion: Steep CT-based IPA can be considered as a new radiologic predictor of complicated postoperative course and SIRS. The role of UAS as well as indications for perioperative antibiotic prophylaxis should be determined in prospective studies.

scholarly journals Urinary tract infection in full-term newborn infants: risk factor analysis

2000 ◽  
Vol 55 (1) ◽  
pp. 9-16 ◽  
Author(s):  
Mário Cícero Falcão ◽  
Cléa Rodrigues Leone ◽  
Renata A. P. D'Andrea ◽  
Roberta Berardi ◽  
Nilce A. Ono ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Parenteral Nutrition ◽  
Urine Culture ◽  
Positive Urine Culture ◽  
Intravascular Catheter ◽  
Positive Urine ◽  
Urinary Tract Malformations

OBJECTIVE: To analyze the correlation of risk factors to the occurrence of urinary tract infection in full-term newborn infants. PATIENTS AND METHODS: Retrospective study (1997) including full-term infants having a positive urine culture by bag specimen. Urine collection was based on: fever, weight loss > 10% of birth weight, nonspecific symptoms (feeding intolerance, failure to thrive, hypoactivity, debilitate suction, irritability), or renal and urinary tract malformations. In these cases, another urine culture by suprapubic bladder aspiration was collected to confirm the diagnosis. To compare and validate the risk factors in each group, the selected cases were divided into two groups: Group I - positive urine culture by bag specimen collection and negative urine culture by suprapubic aspiration, and Group II - positive urine culture by bag specimen collection and positive urine culture by suprapubic aspiration . RESULTS: Sixty one infants were studied, Group I, n = 42 (68.9%) and Group II, n = 19 (31.1%). The selected risk factors (associated infectious diseases, use of broad-spectrum antibiotics, renal and urinary tract malformations, mechanical ventilation, parenteral nutrition and intravascular catheter) were more frequent in Group II (p<0.05). Through relative risk analysis, risk factors were, in decreasing importance: parenteral nutrition, intravascular catheter, associated infectious diseases, use of broad-spectrum antibiotics, mechanical ventilation, and renal and urinary tract malformations. CONCLUSION: The results showed that parenteral nutrition, intravascular catheter, and associated infectious diseases contributed to increase the frequency of neonatal urinary tract infection, and in the presence of more than one risk factor, the occurrence of urinary tract infection rose up to 11 times.

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