Pre-Operative Urine Culture and Intraoperative Pelvic Urine Culture Study in PCNL Patients

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Pre-Operative Urine Culture and Intraoperative Pelvic Urine Culture Study in PCNL Patients

1 Dr. S. M. Kannan, 2 Dr. Revathy C, 3 Malathi G

1 Department of Urology

2 Department of Microbiology- Co author 3 Department of Microbiology Tirunelveli Medical College, Tamil Nadu

Abstract:- Background and Objectives: Urosepsis in Nephrolithiasis cases has increasingly become a risk due to manipulation during PCNL. Also, PCNL being the standard of care in such cases, irrespective of antibiotic coverage and negative pre-operative culture it still poses a threat for development of Urosepsis. The aim of this study is to study the bacterial growth in pre operative urine and intra operative pelvic urine culture in Nephrolithiasis cases. Methods: In this study,Urine samples were collected from 50 patients of Urolithiasis. Samples were subjected to routine culture methods. Bacterial growth if any isolated. Biochemical tests and antibiotic sensitivity pattern of the organism isolated were performed and recorded. Results: Of the study group of 50 patients, Males (59%) outnumbered the females(41%) in the rate of isolation of infection both preoperative and intraoperative culture. The sex ratio (male: female) was 1.75:1. Among preoperative samples 16 (32%) were culture positive and in intraoperative samples 22(44%) found to be culture positive. The predominant organism isolated was found to be E.coli which accounts for 40.9% in both group of samples. Conclusion: This study showed the effectiveness of assessing both the pre operative and intraoperative urine culture as a guide to predict the outcome of the PCNL procedure and to act in a effective way to prevent the development of complication.

INTRODUCTION

Kidney stones affect 10-12% of population. Most common age group is 30-601. Since its introduction, PCNL has become the standard care for patients with large volume Nephrolithiasis. Urosepsis due to manipulation during PCNL can be dangerous despite prophylactic antibiotic coverage and negative pre-operative urine culture.

The most common organism isolated was Escherichia coli followed by other gram negative organisms. In Nephrolithiasis patients, it has been postulated that bacteria in stone may be responsible for systemic bacterial infection2. Recent studies suggest that urine culture is a more accurate

predictor of urosepsis in patients undergoing PCNL for Nephrolithiasis3.

Also intra-operative renal pelvic urine culture is an important factor indicating the development of post- operative systemic inflammatory response syndrome (SIRS)3. Renal calculi pathogens are one of the predisposing factors for infectious agents5. However, pre-operative urine culture often fails to grow colonizing bacteria. Intra- operative pelvic urine culture may be essential in directing the antibiotic regimen4.

AIMS AND OBJECTIVES

To analyze microbial growth in pre operative urine and intra operative pelvic urine by culture.

MATERIALS AND METHODS

Inclusion criteria:

  1. Patients diagnosed with Uolithiasis

  2. Age group- adolescents and adults

Urine samples (pre-operative urine and intraoperative renal pelvic urine) were collected from patients of Urolithiasis. They were then processed according to the standard guidelines. The specimens were inoculated on to nutrient agar(NA), MacConkey agar (MA), Blood agar (BA). The media were incubated at 37C overnight. The growth from positive cultures were identified by its characteristic colony morphology and gram staining. Biochemical tests were performed from the culture isolates grown in respective urine samples. All the isolates were subsequently tested for antibiotic susceptibility based on Kirby-Bauer disk diffusion method on Muller Hinton Agar with antibiotic disks with respect to the type of organism isolated.

RESULTS:

Table 1. Percentage of preoperative urine culture isolates: Among 50 samples 16 (32%) were culture positive and 34 (68%) were culture negative

Total samples

Number of culture positive

Percentage (%)

50

16

32

Table 2. Percentage of intra-operative urine culture isolates: Among 50 samples 22 (44%) were culture positive and 28 (56%) were culture negative

Total samples

Number of culture positive

Percentage (%)

50

22

44

Table.3-Analysis by age and gender:

Age group (In years)

Pre-operative urine culture

Intra-operative urine culture

Positive

Percentage(%)

Negative

Positive

Percentage(%)

Negative

21-30

2

12.5%

6

1

4.55%

7

31-40

3

18.75%

12

4

18.18%

11

41-50

5

31.25%

9

8

36.37%

6

51-60

6

37.5%

7

9

40.9%

4

TOTAL

16

34

22

28

Among the 16 isolates of positive pre operative urine culture, 2 isolates(12.5%) in the age group 21-30, 3 isolates (18.75%) in the age group of 31-40 years, 5 isolates (31.25%) of age group 41-50 and 6 isolates (37.5%) of age group 51-60.

Among the 22 isolates of positive intra-operative pelvic urine culture, 1 isolates(12.5%) in the age group 21-30, 4 isolates (18.75%) in the age group of 31-40 years, 9 isolates (37.5%) of age group 41-50 and 8 isolates (31.5%) of age group 51-60.

Table .4 Distribution of Infection among gender:

Male

Female

Total

Number

Percentage(%)

Number

Percentage(%)

Pre-operative

9

56.25%

7

43.75%

16

Intra-operative

14

63.63%

8

36.36%

22

Males outnumbered the females in the rate of isolation of infection.

Table. 5 Percentage of organisms isolated from urine samples:

6.25

Sl no.

Microorganism

Pre-operative urine culture

Intra-operative pelvic urine culture

No of cases

Percent

No of cases

Percent

1

Escherichia coli

7

43.75

9

40.9

2

Klebsiella pneumonia

5

31.25

6

27.2

3

Pseudomonas aeruginosa

2

12.5

3

13.6

4

Proteus mirabilis

1

1

4.6

5

Enterococcus faecalis

1

6.25

2

9.1

6

Staphylococcus aureus

0

1

4.6

Total

16

100

22

100

From the above table it has been found that E.coli accounts for majority of infection.

CONCLUSION

Pelvic urine culture is recommended in PCNL posted cases to identify the organism in patients at risk for sepsis6. It helps in decision making about the treatment of post-operative infective complication7.

Post operative infection is one of the most common complication due to the pathogenic colonization of the renal stone. This study has showed Renal pelvic urine culture is one of the way to predict and to identify the causative organism and direct antimicrobial therapy.

REFERENCES

  1. Nalini.H.Sofia, Manickavasagam K, Thomas M Walter ., Prevalence and risk factors of kidney stones in India, GJRA, Global Journal for Research Analysis, vol 5, Issue 3, March 2016.

  2. Paramanathan Mariappan, Gordon Smith, Simon V Bariol, Sami A Moussa, David A Tollfy,

  3. Stone and pelvic urine culture sensitivity are better than bladder urine as predictors of urosepsis following PCNL: A Prospective clinical study, May 2005, Vol 173, Issue 5, Pages 1610-1614.

  4. Chen, Dong and Jiang, Chonge and Liang,Xiongfa and Zhong, Fngling and Huang, Jian and Lin et al, (2018), Early and rapid prediction of post operative infections following Percutaneous NephroLithotomy in patients with complex kidney stones. BJU International. 10.1111/bju.14484

  5. Shun Lai, Win and Assimos, Dean (2018). Factors associated with post operative infection after Percutaneous Nephro Lithotomy. Reviews in Urology. 20.7-11.10.3909/riu0778.

  6. Koret R, Graversen JA, Kates M, Meres AC, Gupta M, Post PCNL Systemic Inflammatory Response Syndrome: A prospective analysis of pre-operative urine, renal pelvic urine and stone cultures, J Urol 2011 Nov; 186(5); 1899-903.

  7. Kreydin E, Eisner BH, Risk factors for sepsis after percutaneous renal stone surgery,Nat Reo Urol 2013 Oct; 10(10); 598-605.

  8. Lojanapiwat B, Kirattakarn P, Urol Int 2011; 86(4); 448-52, Role of pre operative and intra operative factors in mediating infection complication following PCNL.

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