Positive preoperative urine culture is a predictor of urinary tract infections and fever following suction mini-PCNL: results from a large, multicenter series from the Endourology section of the European Association of Urology and the STUMPS collaborative group
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background: The clinical utility of preoperative mid-stream urine culture (MSUC) in predicting fever and urinary tract infections (UTIs) after suction-assisted mini-percutaneous nephrolithotomy (SM-PCNL) remains debated. Objectives: This study aims to evaluate the correlation of postoperative fever and UTIs following SM-PCNL in patients with a positive preoperative MSUC versus those with a negative culture. Design: This was a retrospective analysis of a prospectively collected registry including 693 patients from the international STUMPS registry (30 centers and 21 countries). Methods: Patients were stratified by preoperative MSUC results. All positive cultures were treated with targeted antibiotics for ⩾5 days as per the antibiogram; repeated negative cultures before surgery were not mandatory. Intraoperative parameters, 30-day postoperative complications, and stone-free rates (SFR) were evaluated. Multivariable logistic regression was performed to assess independent predictors of infectious complications. Results: Clavien-Dindo grade 1 postoperative fever occurred in 10.6% of patients with positive MSUC versus 4.6% in those with negative cultures. Clavien-Dindo grade 2 infections were more frequent in MSUC-positive patients (4.9% vs 1.2%). Sepsis requiring intensive care occurred in one patient per group. There was no difference in stone compositions and equivalent distribution of infectious stones in both. Intraoperative pelvic urine cultures were more frequently positive in patients with positive MSUC (5.7% vs 0.9%, p < 0.001). No differences were observed in major complications or SFR at 30 days. A positive preoperative MSUC was the only independent predictor of postoperative infection (OR 3.04; 95% CI 1.48–6.12; p = 0.01). Conclusion: Positive preoperative MSUC is independently associated with a higher risk of postoperative fever and UTIs, particularly Clavien-Dindo grade 1 and 2 events, following SM-PCNL. Furthermore, these patients are more likely to have a positive intraoperative urine culture. Therefore, a preoperative MSUC should always be obtained, and a targeted antibiotic therapy should be administered irrespective of stone composition to reduce postoperative infectious risk.
Source: Therapeutic Advances in Urology
Authors: Angelo Cormio, Daniele Castellani, Bhaskar K. Somani, Khi Yung Fong, Nitesh Kumar, Rajiv H. Kalbit, Ivan Gorgotsky, Sundaram Palaniappan, Yiloren Tanidir, Zelimkhan Tokhtiyev, Lazaros Tzelves, Andreas Skolarikos, Esteban Acuña, Leonardo Gomes Lopes, Dmitriy Gorelov, Jaisukh Kalathia, Amish Mehta, Karl Tan, Pankaj Dholaria, Arun Chawla, Edgar Beltrán-Suárez, Zhu Wei, Thomas R. W. Herrmann, Steffi Kar-Kei Yuen, Vineet Gauhar
Institutions: University of Foggia, Marche Polytechnic University, Azienda Ospedaliero-Universitaria delle Marche, European Association of Urology, University Hospital Southampton NHS Foundation Trust, University of Southampton, Sengkang General Hospital, Ford Hospital and Research Centre, José R. Reyes Memorial Medical Center, St Petersburg University, Federal Medical-Biological Agency, National and Kapodistrian University of Athens, Sismanoglio General Hospital, Hospital Provincial de Ovalle, Grupo Santa Casa de Belo Horizonte, First Pavlov State Medical University of St. Petersburg, Veterans Memorial Medical Center, Manipal Academy of Higher Education, Kasturba Medical College, Manipal, Mexican Social Security Institute, Centro Médico Nacional La Raza, First Affiliated Hospital of Guangzhou Medical University, Stellenbosch University, Medizinische Hochschule Hannover, Spital Thurgau (Switzerland), Kantonsspital Frauenfeld, Chinese University of Hong Kong, Ng Teng Fong General Hospital
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,650
OpenAlex ID: W4417195331