Üreteroskopik litotripsi sonrası yerleştirilen double-J stentteki kolonizasyonun klinik önemi göz ardı edilir mi?

Year 2021, Volume: 13 Issue: 2, 47 - 55, 31.07.2021

Mehmet Çağlar Çakıcı , Ferhat Keser , Meftun Çulpan , Özgür Efiloğlu , Uygar Miçooğullari , Ahmet Tahra , Asıf Yıldırım

Abstract

Amaç: Double-J stent (DJS) üzerinde mikroorganizmaların kolonize olmasının önemini değerlendirmek ve idrar yolu enfeksiyonuna (İYE) veya kolonizasyona neden olmayacak veya daha az olmasına neden olacak en güvenli DJS kalma süresini belirlemek. Diğer bir amaç ise DJS kolonizasyonunu etkileyen faktörleri incelemekti.
Gereç ve Yöntemler: Kliniğimizde Kasım 2017-Şubat 2020 tarihleri arasında üreteroskopik litotripsi uygulanan hastaların verileri geriye dönük olarak incelendi ve DJS kültürü olan hastalar çalışmaya dahil edildi. Hastalar DJS kolonizasyonu pozitif (grup 1) ve DJS kolonizasyonu negatif (grup 2) olmak üzere iki gruba ayrıldı.
Bulgular: Ardışık 215 DJS’nin kolonizasyon oranı %31,2 idi. Özellikle 7. dekat ve sonrasında belirgin olmakla birlikte kolonizasyon yaş ilerledikçe daha fazla görüldü (p=0,013). Ortalama DJS kalma süresi grup 1’de 43,1±40,0 gün ve grup 2’de 32,0±15,6 gündü (p=0,032). 4 hafta veya daha az, 4-6 hafta ve 6 haftadan uzun süreli DJS’lerin kolonizasyon oranları sırasıyla %27,5, %26 ve %50 idi (p=0,017). DJS kolonizasyonu, İYE görülmesi ve idrar kültürü pozitifliği ile pozitif korelasyon gösterdi (sırasıyla kappa (κ) katsayısı=0,100, κ=0,216, p<0,05). Çok değişkenli regresyon analizi, İYE’ye neden olan bağımsız risk faktörlerinin stent çıkarılmadan önceki idrar kültürünün pozitif olması (OR:29,487, p<0,001) ve >6 hafta DJS bulunma süresi (OR:7,584, p=0,003) olduğunu gösterdi.
Sonuç: İdrar kültürü pozitifliği ve DJS’nin 6 haftadan uzun sürmesi, DJS’li hastalarda üreteroskopik litotripsi sonrası İYE’yi öngörebilecek faktörlerdir. Ayrıca yüksek komorbidite skoru, İYE öyküsü ve idrar kültürü pozitifliği de DJS kolonizasyonu için bağımsız risk faktörleridir.

Keywords

kolonizasyon, double j stent, üreteroskopi, idrar kültürü, idrar yolu enfeksiyonu, ürolitiyazis.

Supporting Institution

yok

Is the clinical significance of double-J stent colonization following ureteroscopic lithotripsy ignored?

Abstract

Objective: To assess the significance of colonizing microorganisms in double-J stent (DJS) and determine the safest indwelling time of DJS that would cause no or less urinary tract infection (UTI) or colonization. Another objective was to examine the factors that influence DJS colonization.
Material And Methods: The data of patients that underwent ureteroscopic lithotripsy in our clinic from November 2017 till February 2020 were retrospectively reviewed and patients with DJS culture were included in the study. The patients were divided into two groups: DJS colonization positive (group 1) and DJS colonization negative (group 2).
Results: The colonization rate of 215 consecutive DJSs was 31.2%. Colonization increased with increasing age, especially in the 7th decade and later (p=0.013). The mean duration of DJS indwelling was 43.1±40.0 days in group 1 and 32.0 ± 15.6 days in group 2 (p=0.032). The colonization rates of DJS indwelling for 4 week or less, 4-6 weeks, and more than 6 weeks were 27.5%, 26.0% and 50.0%, respectively (p=0.017). DJS colonization positively correlated with development of UTI and urine culture positivity (kappa (κ) coefficient=0.100, κ=0.216, respectively, p<0,05). The multivariate regression analysis showed that the independent risk factors associated with UTI were urine culture positivity before stent removal (OR:29.487, p<0.001) and >6 weeks DJS indwelling time (OR:7.584, p=0.003).
Conclusion: Urine culture positivity and DJS indwelling longer than 6 weeks were the factors that could predict UTI in patients with DJS after ureteroscopic lithotripsy. In addition, high comorbidity score, UTI history and urine culture positivity were independent risk factors for DJS colonization.

Keywords

colonization, double j stent, ureteroscopy, urine culture, urinary tract infection, urolithiasis.

References

• 1. Haleblian G, Kijvikai K, de la Rosette J, Preminger G. Ureteral stenting and urinary stone management: a systematic review. J Urol. 2008;179:424-430.
• 2. Riedl CR, Plas E, Hübner WA, Zimmerl H, Ulrich W, Pflüger H. Bacterial colonization of ureteral stents. Eur Urol. 1999;36:53-59.
• 3. Ben-Meir D, Golan S, Ehrlich Y, Livne PM. Characteristics and clinical significance of bacterial colonization of ureteral double-J stents in children. J Pediatr Urol. 2009;5:355-358.
• 4. Selmi V, Sari S, Oztekin U, Caniklioglu M, Isikay L. External Validation and Comparison of Nephrolithometric Scoring Systems Predicting Outcomes of Retrograde Intrarenal Surgery. J Endourol. 2021;35:781-788.
• 5. Paz A, Amiel GE, Pick N, Moskovitz B, Nativ O, Potasman I. Febrile complications following insertion of 100 double-J ureteral stents. J Endourol. 2005;19:147-150.
• 6. Habash M, Ried G. Microbial biofilms: their development and significance for medical device-related infections. J Clin Pharmacol. 1999;39:887.
• 7. Nevo A, Mano R, Schreter E, Lifshitz DA. Clinical Implications of Stent Culture in Patients with Indwelling Ureteral Stents Prior to Ureteroscopy. J Urol. 2017;198:116-121.
• 8. Zumstein V, Betschart P, Buhmann MT, et al. Detection of microbial colonization of the urinary tract of patients prior to secondary ureterorenoscopy is highly variable between different types of assessment: results of a prospective observational study. Biofouling. 2019;35:1083-1092.
• 9. Akay AF, Aflay U, Gedik A, Sahin H, Bircan MK. Risk factors for lower urinary tract infection and bacterial stent colonization in patients with a double J ureteral stent. Int Urol Nephrol. 2007;39:95-98.
• 10. Ozgur BC, Ekıcı M, Yuceturk CN, Bayrak O. Bacterial colonization of double J stents and bacteriuria frequency. Kaohsiung J Med Sci. 2013;29:658-661.
• 11. Aydin HR, Irkilata L, Aydin M, et al. Incidence of bacterial colonisation after indwelling of double-J ureteral stent. Arch Ital Urol Androl. 2016;87:291-4.
• 12. Nevo A, Golomb D, Lifshitz D, Yahav D. Predicting the risk of sepsis and causative organisms following urinary stones removal using urinary versus stone and stent cultures. Eur J Clin Microbiol Infect Dis. 2019;38:1313-1318.
• 13. Toprak T, Şahin A, Kutluhan MA, et al. Does duration of stenting increase the risk of clinical infection? Arch Ital Urol Androl. 2020;91:237-240.
• 14. Paick SH, Park HK, Oh SJ, Kim HH. Characteristics of bacterial colonization and urinary tract infection after indwelling of double-J ureteral stent. Urology. 2003;62:214-217.
• 15. Al-Ghazo MA, Ghalayini IF, Matani YS, El-Radaideh KM, Haddad HI. The risk of bacteriuria and ureteric stent colonization in immune-compromised patients with double J stent insertion. Int Urol Nephrol. 2010;42:343-347.
• 16. Roushani A, Falahatkar S, Sharifi SH, et al. Intra-operative stone culture as an independent predictor of systemic inflammatory response syndrome after percutaneous nephrolithotomy. Urolithiasis. 2014;42:455-9.
• 17. Osman Y, Elshal AM, Elawdy MM, et al. Stone culture retrieved during percutaneous nephrolithotomy: is it clinically relevant? Urolithiasis. 2016;44:327-32.
• 18. Shoshany O, Margel D, Finz C, et al. Percutaneous nephrolithotomy for infection stones: what is the risk for postoperative sepsis? A retrospective cohort study. Urolithiasis. 2015;43:237-42.
• 19. Shabeena KS, Bhargava R, Manzoor MAP, Mujeeburahiman M. Characteristics of bacterial colonization after indwelling double-J ureteral stents for different time duration. Urol Ann. 2018;10:71-75.
• 20. Kozyrakis D, Perikleous S, Chatzistamou SE, et al. Is There a Role for Double J Stent Culture in Contemporary Urology? Urol Int. 2018;100:203-208.