Is Bacterial Colonization in Ureteral Double-J Stents Significant and Is It Predictable?

Objective: Since microscopic hematuria and pyuria can be observed in patients with a ureteral double-J (DJ) stent in place, urinalysis findings are not considered significant in terms of predicting stent-related infections. This study evaluates the presence of bacterial colonization and the value/ effectiveness of urine tests in predicting the results of DJ stent cultures. Materials and Methods: In the present prospective study, we analyzed data from patients who were treated with a DJ stent placement following endourological surgery due to ureteral stones. DJ stents were removed only after the urine cultures appeared sterile or after a period of empiric antibiotic use. The relationship between urinalysis results and stent cultures was assessed. Results: A total of 65 patients (mean age, 42.6±13.5 years; 16 females and 43 males) were evaluated. Bacterial colonization was detected in 12 (18%) DJ stent cultures with Enterococcus faecalis (n=4), extended-spectrum beta-lactamase producer (ESBL (+) Escherichia coli (n=4), Corynebacterium urealyticum (n=2), candida (n=1) and methicillin-resistant Staphylococcus aureus (n=1) growth being reported. The antibiogram results of the patients that showed colonization in their cultures demonstrated penicillin (n=4), ampicillin (n=4), tetracycline (n=3), imipenem (n=2), and linezolid (n=1) sensitivity. The rate of leukocyte esterase- and nitrite-positive patients, of those having significant number of leukocytes, and urine culturepositive patients in the groups with and without positive urine culture was 58.5%, 32%, 49%, and 7.5% vs 50%, 16.6%, 50%, and 8.5%, respectively. There were no statistically significant differences between the groups (p=>0.05). None of the study patients applied to our hospital with active infection following DJ stent removal. Conclusion: Urinalysis is insufficient in predicting catheter culture results. Based on the results of this study, we assume that stent culture for removed DJ stents is not a necessity; empirical antibiotic therapy with ampicillin-tetracycline should be started in patients with postoperative infection.

Üreteral Double J Stentlerde Bakteri Kolonizasyonu Anlamlı mıdır ve İdrar Testleri ile Tahmin Edilebilir mi?

Amaç: Üreteral Double-J (DJ) stent takılan hastalarda mikroskobik hematüri ve piyüri sıklıkla eşlik ettiğinden, idrar analizleri enfeksiyonları öngörme açısından anlamlı sayılmazlar. Bu çalışma, üreteral DJ stent kültür sonuçlarını öngörmede idrar testlerinin değeri/ etkinliği değerlendirmektedir. Gereç ve Yöntem: Endoskopik üreter taşı tedavisi sonrası üreteral DJ stent takılan hastaların verileri prospektif olarak analiz edildi. İdrar tahlilinde lökosit esteraz pozitifliği, nitrit pozitifliği, anlamlı lökosit varlığı ve idrar kültüründe üreme ile üreteral DJ stent kültüründe üreme arasındaki ilişki değerlendirildi. Bulgular: Ortalama yaşı 42±68 yıl olan 16 kadın ve 49 erkek toplam 65 hasta çalışmaya dahil edildi. Üreteral DJ stent kültürlerinin 12’sinde (%18) bakteri kolonizasyonu tespit edildi. Üreteral DJ stent kültürlerinde Enterokok faecalis (n=4), Escherichia coli (n=4), Corynebacterium urealyticum (n=2), kandida (n=1) ve metisilin rezistan staphylococcus aureus (n=1) üremesi raporlandı. Üreteral DJ stent kültür antibiyogramlarında penisilin (n=4), ampisilin (n=4), tetrasiklin (n=3), imipenem (n=2), ve linezolid (n=1) duyarlılğı rapor edildi. Lökosit esteraz pozitifliği, nitrit pozitifliği, anlamlı lökositüri ve idrar kültüründe üreme oranları Üreteral DJ stent kültüründe üreme olan ve olmayan gruplar için sırasıyla %58,5 vs. %50, %32 vs. %16,6, %49 vs. %50 ve %7,5 vs. %8,5 hesaplandı ve gruplar arasında anlamlı farklılık izlenmedi (p>0,05). Üreteral DJ stent çıkarılmasından sonra aktif enfeksiyon ile başvuru izlenmedi. Sonuç: Steril idrar kültürü ve idrar tahlili parametreleri üreteral DJ stent kültür sonuçlarını öngörmede yetersizdir. Bulgularımıza göre çıkarılan üreteral DJ stentleri mikrobiyolojik inceleme yapmak klinik uygulamamıza katkı sağlamamaktadır. Ampisilin-tetrasiklin tedavisine postoperatif enfeksiyon bulguları olan hastalarda ampirik olarak başlanmalıdır

Kaynakça

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