Timing of midstream urine culture before endourological procedure —can we do better?—A comparative study

In this study, we sought to investigate the role of positive UC in the 90  days prior to surgery (90PreOp) in predicting postoperative infectious complications in comparison to a single positive preoperative UC (PreOP). We compared the correlation between positive PreOp UCs and positive 90PreOp UCs with postoperative urosepsis, and a positive UC obtain proximal to obstru ction (Prox UC) during percutaneous nephrolithotomy, ureteroscopy and a placement of nephrostomy tube or ureteral stent. Data from 140 consecutive patients were collected. PreOp UCs were positive in 15 (11%) of patients versus 31 of 140 (22%) positive 90PreOp UCs. All six sepsis events had a positiv e 90PreOp UC, and five had a positive PreOp UC. Fourteen (93.3%) out of 15 positive Prox UC had a positive 90PreOp UC, whereas only 7 (38.9%) had a positive 90PreOp UC. Positive 90PreOp UC outperformed PreOp UC in predicting positive Prox UC, OR = 12.8 (95% CI 3.70–44.30,p <  0.001), versus OR of 88.9 (95% CI 11.0–720.7,p <  0.001); sensitivity 93%(95% CI 68–100%) versus 47%(95% CI 21–73%); as well as area under the ROC curve(AUC), 0.90 (CI 0.80–0.95) for 90PreOp versus 0.70 (CI 0.56–0.82) for positive Prox UC. Uropathogen persistence was better identified when using 90PreOp UC (27%) than using PreOp UC (12%) . We suggest reviewing UCs taken within 90 days preoperatively as this was found superior to a single preoperative midstream UCs in predicting postoperative infectious sequela a...
Source: Urolithiasis - Category: Urology & Nephrology Source Type: research