Presentation Authors: Eyal Kord*, Yoram I Siegel, Galina Goltsman, zerifin, Israel, Sivan Hirsh, Tel aviv, Israel, Amnon Zisman, zerifin, Israel
Introduction: The optimal time frame for definitive stone treatment in stented patients after an event of urosepsis is not well defined. Objective: to evaluate clinical parameters, bacteriology and risk factors for an event of recurrent infection in stented patients following a septic event prior to definite treatment for ureterolithiasis.
Methods: The records of 176 patients who presented with urosepsis and ureterolithiasis between 2009-2017 and primarily drained with a DJ stent, were reviewed. A comparison was carried out between 129 patients with no additional medical or surgical events while awaiting definitive treatment and 47 patients (27%) who experienced an even of recurrent infection prior to definitive stone treatment.
Results: 47/176 (27%) stented patients experienced additional infectious event. 47% of patients with recurrent infection present within 4 weeks following the primary septic episode. Mortality: one case (0.8%) during the primary episode and three cases (6.3%) during re-admission. Most common pathogens isolated from urinary samples during the primary septic episode were E.Coli (19%), Proteus Mirabilis (7.2%), Enterococus Faecalis (5.8%) and Klabsiella pneumonia (4.8%). 28% (49/176) had positive blood cultures. In 9.7% of patients resistant bacteria grew in the urine (Pseudomonas A, Acinetobacter baumani, ESBL positive E.Coli/ Klabsiella P/ Proteus M). During recurrent infection, there was more than a threefold increase in resistant bacteria culture growth. 57% of patients with recurrent infection had a change in urinary bacterial growth or acquired multibacterial growth in comparison to their primary hospitalization_x000D_
The presence of hypertension (p=0.03), CKD (p=0.05), hyperglycemia (p=0.02), AKI (p=0.001) and deferred diagnosis of sepsis (p=0.01) in the first admission were found to be independent risk factors for recurrent infection. In a multivariate analysis significant odds ratio for recurrent infection were obtained for AKI (OR 1.41, p=0.002) and hyperglycemia (OR 2.05, p=0.048).
Conclusions: Patients with AKI or hyperglycemia during initial hospitalization are at risk for recurrent infection after drainage with DJ stent for urosepsis associated with ureterolithiasis. During the period between drainage and definite stone treatment, an episode of recurrent infection is associated with an increased risk of resistant bacteria and mortality. It is pertinent that the optimal timing for definite stone treatment in this specific subset of patient will be studied in prospective study.