Challenges in Diagnosing and Treating Percutaneous Nephrostomy-Related Urinary Tract Infection in Cancer Patients: A...

We aimed to evaluate medical decisions regarding urinary tract infection (UTI), describe associated microorganisms, and assess potential risk factors for percutaneous nephrostomy-related UTI (UTI-PN).

Oncological patients who underwent percutaneous nephrostomy (PN) were included. We assessed percutaneous nephrostomy procedure-related UTI (UTI-PNp) when the UTI occurred until 7 days after the PN and percutaneous nephrostomy catheter-related UTI (UTI-PNc) when the UTI occurred > 7 days after PN.

A total of 734 PN procedures were performed (45.4% first catheter placement, 54.6% catheter replacement). Fever was the primary clinical indicator guiding treatment decisions for both UTI-PNp (43.3%; 26/60) and UTI-PNc (44.6%; 99/222). Leukocyturia, either alone or combined with turbid urine, foul-smelling urine, or leukocytosis, influenced treatment decisions in 5.0% (3/60) of UTI-PNp cases and 17.1% (38/222) of UTI-PNc cases. No risk factors were identified for UTI-PNp; however, the time between urinary tract obstruction and the placement of the PN for decompression increased the odds of developing UTI-PNc. Among urine cultures, multidrug-resistant bacteria accounted for 57.7% (41/71) in cases with three to six antibiotic use episodes, compared to 42.3% (30/269) of cases of multidrug-sensitive bacteria (p < 0.001).

Beyond the paramount importance of achieving an accurate infection diagnosis to mitigate the prevalence of multidrug-resistant bacteria, our results highlight differences between UTI-PNc and UTI-PNp, including risk factors, underscoring the need for distinct approaches to UTI-PN.