Does preoperative urine culture still play a role in predicting post-PCNL SIRS? A retrospective cohort study

There is controversy regarding the predicting value of preoperative urine culture for post-percutaneous nephrolithotripsy (PCNL) infection. The purpose of our study was to re-evaluate the importance of preoperative urine culture for developing post-PCNL systemic inflammatory response syndrome (SIRS) in China. A total of 303 patients undergone PCNL from March 2012 to January 2018 were recruited. Urine tests, urine cultures and the perioperative data were prospectively recorded and analyzed. 95 patients (31.4%) were identified with positive preoperative urine cultures. Female patients had significantly higher rate of urine cultures positivity than that in male patients (42.9% vs. 21.5%, p < 0.01). Escherichia coli was the most common organism (56 cases, 58.9%) in patients with positive urine cultures and 35.7% of E. coli-positive patients developed SIRS after PCNL. Even with intensive perioperative prophylaxis, patients with positive urine cultures had a higher rate of post-PCNL SIRS than those patients with negative urine cultures (p = 0.043). On multivariable analysis, preoperative positive urine cultures (OR 1.943, 95% CI 1.11-3.39, p = 0.019), preoperative neutrophils (OR 1.228, 95% CI 1.07-1.41, p = 0.003), intraoperative pyonephrosis (OR 3.37, 95% CI 1.44-9.71, p = 0.01) and postoperative hospitalization (OR 1.154, 95% CI 1.05-1.28, p = 0.005) were independent risk factors for postoperative SIRS. These results demonstrated that preoperative urine culture still played a role in predicting post-PCNL SIRS, but it was unable to prevent the occurrence of SIRS even with intensive perioperative prophylaxis based on urine culture results. Further studies are required to explore the predicting role of advanced preoperative bacterial detecting techniques in post-PCNL infectious complications.