Heterogeneity in stone culture protocols and endourologist practice patterns: a multi-institutional survey

Area of Science:

• Urology
• Infectious Diseases
• Medical Microbiology

Background:

• Kidney stone cultures can identify pathogens missed in urine cultures.
• Current clinical guidelines do not address stone culture protocols.
• Practices regarding stone culture performance and utilization are largely unknown among endourologists.

Purpose of the Study:

• To investigate the current practices of endourologists in performing kidney stone cultures.
• To understand the conditions, methods, and influencing factors for ordering stone cultures.
• To assess how stone culture results guide post-operative antibiotic use.

Main Methods:

• A comprehensive electronic survey using REDCap was distributed to endourologists specializing in kidney stone disease.
• The survey collected data on clinical scenarios, antibiotic duration, and institutional laboratory protocols for stone cultures.
• Logistic regression analysis identified factors associated with performing stone cultures.

Main Results:

• Only 50% of respondents had a specific 'stone culture' order available; 32% used urine culture orders for stones.
• Antibiotic duration for positive stone cultures varied, with 4-7 days being most common (46%).
• More years in practice correlated with fewer cultures ordered, while higher percutaneous nephrolithotomy volume correlated with more cultures.

Conclusions:

• Endourologists exhibit diverse practices in ordering stone cultures and using results to guide antibiotic therapy.
• Inconsistent institutional microbiology laboratory protocols for stone cultures necessitate standardization.
• Standardized protocols are crucial for future studies evaluating the clinical utility of stone cultures and developing evidence-based guidelines.