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. 2018 Sep;59(5):335-341.
doi: 10.4111/icu.2018.59.5.335. Epub 2018 Jul 23.

Clinical characteristics of postoperative febrile urinary tract infections after ureteroscopic lithotripsy

Jin Woo Kim  1 , You Jin Lee  1 , Jae-Wook Chung  2 , Yun-Sok Ha  1 , Jun Nyung Lee  2   3 , Eun Sang Yoo  1   3 , Tae Gyun Kwon  2   3 , Bum Soo Kim  1   3
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Clinical characteristics of postoperative febrile urinary tract infections after ureteroscopic lithotripsy

Jin Woo Kim et al. Investig Clin Urol. 2018 Sep.

Abstract

Purpose: Ureteroscopic lithotripsy (URS) is gaining popularity for the management of ureteral stones and even renal stones, with high efficacy and minimal invasiveness. Although this procedure is known to be safe and to have a low complication rate, febrile urinary tract infection (UTI) after URS is not rare. Therefore, we aimed to analyze the risk factors and causative pathogens of febrile UTI after URS.

Materials and methods: Between January 2013 and June 2015, 304 patients underwent URS for ureteral or renal stones. The rate of postoperative febrile UTI and the causative pathogens were verified, and the risk factors for postoperative febrile UTI were analyzed using logistic regression analysis.

Results: Of 304 patients, postoperative febrile UTI occurred in 43 patients (14.1%). Of them, pathogens were cultured in blood or urine in 19 patients (44.2%), and definite pathogens were not identified in 24 patients (55.8%). In patients with an identified pathogen, Pseudomonas aeruginosa had the highest incidence. Multivariate analysis showed that the operation time (p<0.001) was an independent risk factor for febrile UTI after URS. The cut-off value of operation time for increased risk of febrile UTI was 70 minutes.

Conclusions: Overall, febrile UTI after URS occurred in 14.1% of patients, and the operation time was an independent predictive factor for this complication. Considering that more than 83.7% of febrile UTIs after URS were not controlled with fluoroquinolones, it may be more appropriate to use higher-level antibiotics for treatment, even in cases with unidentified pathogens.

Keywords: Lithotripsy; Ureteroscopy; Urinary tract infection.

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Conflict of interest statement

CONFLICTS OF INTEREST: The authors have nothing to disclose.

Figures

Fig. 1
Fig. 1. Antibiotics' administration algorithm.
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