Study Of Correlation Between Bacteriology Of Upper Urinary Tract Calculi And Systemic Inflammatory Response Syndrome After Mini-percutaneous Nephrolithotomy

[Objective] To investigate the correlation between bacteriology of upper urinary tract calculi and systemic inflammatory response syndrome (SIRS) after mini-percutaneous nephrolithotomy (mPNL).[Methods] All patients with upper tract urinary calculi from April 2004 to Janusry 2008 were chosen, who underwent mPNL. Before operation midstream urine was obtained for culture.During operation pelvic urine and fragmented stones were obtained for culture. After suegery, all postoperative SIRS events were monitoredjncluding temperature, heart rate, respiratory rate, arterial carbon dioxide pressure and white cell count. We obtained the patient' blood for culture that developed SIRS after mPNL.[Results] There are 146 patients who fulfilled the criteria of study, of whom 62(42.5%) patients' samples (midstream urine/pelvic urine/stones), were cultured and had at least one positive item,. In 146 patients 30(20.5%) had positive stone culture, 37(25.3%) had positive pelvic urine, and 27(18.5%) had positive midstream urine. Escherichia were the predominant bacteria. The infection rates of midstream urine with infectious stones had no a significant difference with non-infectious stones (p>0.05). The infection of pelvic urine in patients with factious stones were significantly higher than those with non-infectious stones (p<0.01). The incidence of positive pelvic urine culture in these patients with moderate or severe hydronephrosis was significantly higher than in those without obvious dilatation (p<0.05). 36 patients (24.7%) had SIRS after mPNL, 4 of these patients had positive blood culture, none of patients developed septic shock. Positive pelvic urine culture and infected stones predicted SIRS after mPNL had statistical significance, midstream urine culture did not predict SIRS.[Conclusions] 42.5% patients (62 / 146) who need mPNL have positive urinary tract infection, and 81% patients (50 / 62) have positive upper urinary tract infection, whichcan be diagnosed by culturing pelvic and stones. Escherichia were the predominant bacteria.The incidence of positive pelvic urine is relative to the hydronephrosis. Positive or negative midstream urine can not represent upper urinary tract infections. The incidence of SIRS is related to positive pelvic urine culture and infected stones, There is a poor correlation between infection midstream urine and incidence of SIRS. It is necessary to use prophylactic antibiotics before mPNL. The collections of pelvic urine and stones for culture and sensitivity are necessary, which can direct treatment of antibiotics when patients develop generalized infection. Therefore, it is routine to collect pelvic urine and stones for culture and sensitivity.