Investig Clin Urol.  2018 Sep;59(5):335-341. 10.4111/icu.2018.59.5.335.

Clinical characteristics of postoperative febrile urinary tract infections after ureteroscopic lithotripsy

• Kim JW
• Lee YJ
• Chung JW
• Ha YS
• Lee JN
• Yoo ES
• Kwon TG
• Kim BS

• KMID: 2419417
• DOI: http://doi.org/10.4111/icu.2018.59.5.335

Abstract

PURPOSE
Ureteroscopic lithotripsy (URS) is gaining popularity for the management of ureteral stones and even renal stones, with high efficacy and minimal invasiveness. Although this procedure is known to be safe and to have a low complication rate, febrile urinary tract infection (UTI) after URS is not rare. Therefore, we aimed to analyze the risk factors and causative pathogens of febrile UTI after URS.
MATERIALS AND METHODS
Between January 2013 and June 2015, 304 patients underwent URS for ureteral or renal stones. The rate of postoperative febrile UTI and the causative pathogens were verified, and the risk factors for postoperative febrile UTI were analyzed using logistic regression analysis.
RESULTS
Of 304 patients, postoperative febrile UTI occurred in 43 patients (14.1%). Of them, pathogens were cultured in blood or urine in 19 patients (44.2%), and definite pathogens were not identified in 24 patients (55.8%). In patients with an identified pathogen, Pseudomonas aeruginosa had the highest incidence. Multivariate analysis showed that the operation time (p < 0.001) was an independent risk factor for febrile UTI after URS. The cut-off value of operation time for increased risk of febrile UTI was 70 minutes.
CONCLUSIONS
Overall, febrile UTI after URS occurred in 14.1% of patients, and the operation time was an independent predictive factor for this complication. Considering that more than 83.7% of febrile UTIs after URS were not controlled with fluoroquinolones, it may be more appropriate to use higher-level antibiotics for treatment, even in cases with unidentified pathogens.

Keyword

Lithotripsy; Ureteroscopy; Urinary tract infection

MeSH Terms

Anti-Bacterial Agents
Fluoroquinolones
Humans
Incidence
Lithotripsy*
Logistic Models
Multivariate Analysis
Pseudomonas aeruginosa
Risk Factors
Ureter
Ureteroscopy
Urinary Tract Infections*
Urinary Tract*
Anti-Bacterial Agents
Fluoroquinolones

Figure

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  Fig. 1 Antibiotics' administration algorithm.

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