Presentation Authors: Carlos Mejia Arbelaez*, Alan Yaghoubian, Timothy Batter, Dianne Sacco, Boston, MA, Ben Chew, Vancouver, Canada, Manoj Monga, Cleveland, OH, Amy Krambeck, Indiannapolis, IN, Roger Sur, San Diego, CA, Bodo Knudsen, Columbus, OH, Nina Mikkilineni, Ojas Shah, New York City, NY, Karen Stern, Scottsdale, AZ, Smita De, Nicole Miller, Nashville, TN, Tatevik Broutian, Michael Sourial, Justin Rose, Columbus, OH, Tim Large, Indiannapolis, IN, Kymora Scotland, Colin Lundeen, Dirk Lange, Vancouver, Canada, Thomas DiPina, Seth Bechis, San Diego, CA, Brian Eisner, Boston, MA
Introduction: In recent years, obtaining stone culture has become common practice during percutaneous nephrolithotomy (PCNL) as it most accurately predicts bacteria responsible for post-operative sepsis. However, to date, no studies have performed a detailed analysis of the relationship between specific bacterial species and risk of sepsis after PCNL.
Methods: A retrospective review of 340 PCNL procedures was performed. We used the qSOFA (quick sequential organ failure assessment), a scoring system recently devised for the prediction of sepsis risk which has been shown in multiple studies to be more accurate than SIRS criteria. Inclusion criteria were stone culture species minimum number of 10; all stone culture species with < 10 incidents in our database were excluded due to lack of data.
Results: Three-hundred twenty-five patients (325) met inclusion criteria. The percentage of patients with each stone culture species that met qSOFA criteria (i.e. had increased risk of sepsis) after PCNL were as follows: negative stone culture = 10%, candida = 0%, e. coli = 6.3%, enterococcus = 8.1%, klebsiella = 0%, proteus = 40%, providencia = 0%, pseudomonas = 15.4%, staphylococcus species = 9.5%.
Conclusions: In this multi-center study, we demonstrate that stone culture species may be related to risk of development of sepsis . Certain bacteria appear to be more virulent than others. 40% of patients with stone culture positive for proteus demonstrated positive qSOFA scores, whereas that rate was 15% or less for all other stone culture species. Interestingly, even in patients with a negative stone culture, 10% of patients met qSOFA criteria. These data may help surgeons, anesthesiologists, and critical care physicians plan supportive care during and after PCNL procedures.