Renal stone culture and sensitivity is a better predictor of post pcnl urosepsis than pelvic or midstream urine culture and sensitivity – our institutional experience

Background and Aim: Urosepsis is a serious complication following percutaneous nephrolithotomy (PCNL) and can occur in spite of preoperative sterile urine culture and prophylactic antibiotics. The aim of the study was to analyze the utility of cultures of midstream urine (MSU), renal pelvic urine, and crushed stones for prediction of post operative urosepsis following PCNL
Materials and Methods: We performed a prospective clinical study in consecutive patients undergoing PCNL between October 2016 and March 2018. The samples collected for culture and sensitivity (C and S) were (1) Mid stream urine one day before surgery, (2) Urine from pelvicaliceal system during percutaneous puncture, and (3) Stone fragments collected during the procedure. All the patients were monitored during the postoperative period for symptoms and signs of urosepsis. The data collected were divided into 3 main groups, i.e., MSU C and S, pelvic urine C and S, and stone C and S, and were analyzed to determine association with urosepsis.
Results: A total of 83 patients were included. The MSU C and S was positive in 10.8%, pelvic C and S in 13.7%, and stone C and S in 30.1% patients. Twenty patients had systemic inflammatory response syndrome (SIRS) and 3 patients had septic shock. Out of the 20 with SIRS, 17 cases were stone C and S positive, 6 were pelvic urine C and S positive, and 2 patients had positive MSU C and S.
Conclusion: Stone C and S is a better predictor of potential urosepsis than pelvic urine and MSU C and S, which often fail to grow stone colonizing bacteria. We recommend routine collection of stone for C and S for the diagnosis and management of urosepsis after PCNL.