Correlation Among Intraoperative Renal Pelvis Urine Culture,Stone Culture And Preoperative Urine Culture And Their Influence On Postoperative Urosepsis In PCNL

Objective:To explore the correlation among intraoperative renal pelvis urine culture,stone culture and preoperative urine culture and their influence on postoperative urosepsis in percutaneous nephrolithotomy(PCNL).Methods:A total of 220 PCNL patients treated in the China-Japan Union Hospital of Jilin University from October 2018 to December 2019 were retrospectively recruited for analyses,involving 98 males and 122 females,with an average age of 41.79±4.41 years(35-55 years).There were 36 patients with diabetes mellitus.In addition,there were 75 patients with renal stone94 with ureteral stone,51 with both renal and ureteral stones,20 with staghorn renal stone,and 31 combined with hydronephrosis The average size of stones was 3.26±1.22 cm(0.5-6.0cm).The average operation time of PCNL patients was 101.81±31.45 min(30-250 min).All recruited patients were successfully operated with only one surgical access.Midstream urine cultures were performed before the operation on all patients,and those with positive results required for further symptomatic treatment based on the bacterial culture results until the urine culture results turned to be negative;While those with negative results of preoperative urine culture test were treated with antibiotics for preventing infection.During the operation,the renal pelvic urine was drained by B-ultrasound puncture for culture.Ultrasound detritus was performed,and larger stones were collected for culture.Postoperative vital signs were closely monitored.The positive rates of midstream urine culture,renal pelvic urine culture and bacterial culture of renal stone were compared,and their correlation to postoperative sepsis was analyzed.Moreover,the correlation between postoperative sepsis,and the age,gender,stone size,hydronephrosis,staghorn renal stone,diabetes mellitus and operation time was assessed.Results:Among the 220 patients,Escherichia coli was the main type of bacteria cultured in midstream urine and renal pelvis urine,accounting for 62.7%(32/51)in 32 cases and 42.9%(42/98)in 42 cases,respectively.On the contrary,Staphylococcus epidermidis was the main type of bacteria cultured in renal stone,occupying 58.4%(59/101)in 59 cases.The comparison of the bacterial culture results in the three groups revealed significant differences(P < 0.05).The results displayed that the proportion of patients whose midstream urine was positive took up 23.2%(51/220),the proportion of patients with positive renal pelvis culture was44.5%(98/220),and the proportion of patients with positive stone culture accounted for 46.0%(101/220),with significant differences among the three data(P < 0.05).The incidence of urosepsis was 5%(11/220),the incidence of urosepsis in patients with positive urine culture was 2.0%(1/51)and the incidence of urosepsis in patients with negative urine culture was 5.9%(10/169).There was no statistical significance between the two groups(P > 0.05).For positive and negative patients with peliuria culture,postoperative urosepsis rates were 9.2%(9/98)and 1.6%(2/122),respectively,with statistical significance(P < 0.05).In terms of patients with positive and negative renal stone culture,postoperative urosepsis rates were 8.91%(9/101)and 1.7%(2/119),respectively,with statistical significance(P < 0.05).The independent risk factors for postoperative urosepsis included positive stone culture,positive renal pelvis urine culture,staghorn renal stone,diabetes,and long operation time.Age,sex,stone size,hydronephrosis and positive midstream urine culture had no correlation with postoperative urosepsis.Conclusion:Preoperative midstream urine culture cannot be served as a predictive indicator for postoperative sepsis in PCNL patients,which is unable to accurately reflect the results of stone and renal pelvic urine cultures.Routine cultures of renal pelvic urine and renal stones of PCNL patients are of great significance to predict the incidence of postoperative sepsis.Notably,PCNL patients with staghorn renal stone,long operation time and diabetes mellitus are more likely to suffer from postoperative infections like urosepsis.