A prospective Comparative Clinical Study on Bladder Urine, Pelvic Urine and Renal Stone Culture & Sensitivity in Predicting Urosepsis Following Percutaneous Nephrolithotomy

Abstract

Background: Urosepsis means a severe infection of urinary tract (UTI) and/or male genital tract (prostate) with features consistent with systemic inflammatory response syndrome. UTI may occur among all the age groups and produce a broad range of clinical syndromes ranging from asymptomatic bacteriuria to acute pyelonephritis with gram negative sepsis to septic shock. It is estimated that the mortality rate due to urosepsis ranges from 30 to 40 p.c respectively. Urosepsis may also cause multiple organ dysfunction, hypoperfusion or hypotension. Urosepsis due to percutaneous nephrolithotomy may be catastrophic despite prophylactic antibiotic coverage and negative midstream urine culture and sensitivity testing (C&S) and bacteria in the stone can be responsible for systemic infection. The aim of the study is to compare bladder urine (culture      & sensitivity) and collecting system urine and stone (culture and sensitivity) in predicting urosepsis following percutaneous nephrolithotomy. Subjects and Methods: A hospital-based, analytical prospective clinical study was conducted among thirty cases who were present during   the study period and had undergone percutaneous nephrolithotomy (PCNL). Cases were included irrespective of gender with renal calculi       in whom percutaneous nephrolithotomy was about to be done at Narayana Medical College & Hospital, Chintareddypalem, Nellore, Andhra Pradesh during 1st February 2014 to 31st January 2015. Data collected was divided into three main groups Midstream urine (C&S); Pelvic urine (C&S); and Stone (C&S) respectively. Data obtained was entered in Microsoft Excel-2013 and analyzed in SPSS version-22 trial. Appropriate statistical tests were applied and p-value less than 0.05 was considered as significant. Results: Bladder urine (C&S) was positive in 3/30 (10.00%) patients, Pelvic urine (C&S) in 5/30 (16.66 %) patients and Stone (C&S) in 8/30 (26.66 %) patients. Most of the infected specimens grew Escherichia coli followed by pseudomonas, klebsiella, enterococcus. Systemic Inflammatory Response Syndrome (SIRS) was reported among 26.7 p.c (8) of the patients. In one patient (3.33%) septic shock developed but no deaths were reported. Conclusion: Stone (C&S) and Pelvic urine (C&S) are better predictors of urosepsis than Bladder urine (C&S).