SEPSIS IN POST-PCNL PATIENTS; RISK FACTORS AND INFLUENCE OF STONE CULTURES.

Abstract

Objective: Post-operative sepsis is a well known complication of various endourologic procedures especially PCNL and it is caused by stone fragmentation containing toxins and bacteria with subsequent toxaemia and bacteremia. The present study was to determine clinical role of stone culture in modifying treatment and assess the factors that may increase the risk to develop sepsis after PCNL . Methods: A total of 211 patients (119 males and 92 females) with a mean age of 38.2 years were enrolled in this study at our single centre tertiary care institute . Patients with preoperative positive urine culture and sensitivity were excluded . All patients received prophylactic 3rd generation cephalosporin intravenously at the time of anaesthesia induction. Stone culture was taken from all patients after puncturing the pelvicalyceal system and sent for culture and sensitivity. Patients were monitored closely in the postoperative period for the development of SIRS. Risk factors such as diabetes, age, degree of hydronephrosis, residual fragments, number of access points PCNL type (standard versus mini) and stone burden were evaluated for the association with SIRS. Results: Mean duration of the operations was 82.7 min (30 to 110 min. ). 19 patients(9.0 %) developed post PCNL SIRS Stone culture identied organisms in8 patients(42% of patient cohort ). Treatment plan was changed as per antibiotic culture sensitivity in only one patientwith culture sensitivity report in three patients being multi drug resistant and rest responded to antibiotics they were receiving already. Statistically signicant factors for post PCNL fever were diabetes mellitus (DM) (p = 0.001), stone burden (p = 0.004), and degree of hydronephrosis (p = 0.04). Conclusion: Doing intraoperative stone cultures sensitivity does not confer additional benet for antibiotic change in majority of cases.DM, staghorn stones, degree of hydronephrosis, duration of the operation and number of tracts are risk factors for post PCNL SIRS.