Recurrent infection stones with apparently negative cultures. The case for blind antibacterial treatment

Infection stones in the urinary tract are always associated with infection with a urease-producing, urea-splitting organism. The most common of these organisms are easy to culture and identify and can be treated early either with an appropriate antibiotic or with an anti-urease agent. Ureaplasma urealyticum and Corynebacterium urealyticum are urease-producing organisms which are difficult to grow; their presence and effects frequently go undetected and untreated. Other organisms, as yet unknown, may also be involved in the same process. We report the first series of 8 patients with recurrent infection-type stones likely to have been caused by a "hard to grow" organism. Five patients never had a positive culture; in 2 patients 1 of 10 urine cultures grew a coagulase-negative Staphylococcus and in 1 patient the same organism was grown from a stone but never in the urine. The clinical course of all of these patients was significantly improved after blind treatment with antibiotics and in one case with an anti-urease agent.