Characterizing Neurogenic Bladder Patients Undergoing Percutaneous Nephrolithotomy: Examining Concordance of
Nicolas Siron1, Zaki Hafeez1, Vishwasree Samala1
1Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Introduction:
Percutaneous nephrolithotomy (PCNL) is associated with a significant risk for postoperative urinary tract infection (UTI) and sepsis. Prevention of post-PCNL UTI is dependent on appropriate antibiotic prophylaxis (AP), which relies on preoperative urine cultures. However, studies have demonstrated that preoperative urine cultures are not always concordant with stone cultures (SC), the latter most closely representing the bacterial burden. Accuracy of urine cultures is even more critical in the neurogenic bladder (NB) subpopulation, as they often have infected or infectious stones. In this study, we aim to assess the concordance of preoperative urine cultures and SC in NB patients as compared to non-neurogenic bladder (non-NB) patients undergoing PCNL.
Methods:
We performed a retrospective chart review of all patients ≥18 years old undergoing PCNL at our institution between 2022 and 2024. Baseline characteristics, preoperative urine culture, stone culture, concordance rates, perioperative complication, and urosepsis rates were collected and compared between NB and non-NB patients. Numeric variables were compared using t-test and categorical variables using chi-square.
Results:
A total of 333 patients underwent PCNL between 2022 and 202 were non-NB patients. NB patients had a lower concordance rate between preoperative urine culture and SC compared to non-NB patients (37.7% vs 64.3%, p = < 0.05). Rates of urosepsis were comparable in both groups in the perioperative period (1.8% vs 1.4%, p = 0.51). Enterococcus faecalis was the most common pathogen found in NB SC.
Conclusion:
NB patients are more likely to have discordant preoperative urine culture and SC compared to non-NB patients. Gram-positive organisms such as Enterococcus faecalis also represent a high number of positive SC in this population. Given the high discordance rate and positivity with Enterococcus faecalis in SC, consideration for a larger spectrum AP is warranted in NB patients.
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