Importance of microbiological evaluation in management of infectious complications following percutaneous nephrolithotomy

Abstract

Aim: To evaluate the infectious complications, microorganism distribution and antibacterial treatment in patients who underwent percutaneous nephrolithotomy (PCNL).

Patients and methods: Three hundred and thirty-eight patients who were 17 years age or older who underwent PCNL between January 2001 and December 2002 have been evaluated retrospectively. Urine cultures obtained before, during and after PCNL and cultures of stone fragments, extracted during PCNL, were analyzed. Eighty-two patients, who have been referred to Section of infectious disease because of postoperative fever (Group 1; 58 males, 24 females, mean age: 45.5 years) and the remainder of patients (Group 2; 169 males, 87 females, mean age: 44.5 years) were compared in regard to infectious complications and microbiological culture results.

Results: The evaluation of peroperative urine cultures revealed that patients in Group 1 had more positive urine cultures than the other group. The analysis showed fever developed more frequently in patients with positive stone cultures and also in patients with positive peroperative urine. Overall, during the study period, five of 338 (1.5%) patients developed sepsis and none of them was lost due to sepsis. Comparison of two groups revealed that patients in Group 1 had a larger stone burden, longer operative time and longer postoperative hospital stay than patients in Group 2.

Conclusion: Fever and bacteriemia after PCNL are common, through progression to sepsis is rare. Recovery is possible with a high degree of suspicion, early intervention and intensive treatment. The results of cultures taken preoperatively, peroperatively and during the febrile period have great importance for decision of required changes during the treatment.