K. Bhargava Vardhana Reddy 1 , R. Malleswari 2 , Sridevi S
ABSTRACT: INTRODUCTION: Percutaneous nephrolithotomy (PCNL) is the most frequently performed surgery for stone disease at our institution. Nearly 100 PCNL procedures are being performed in a year at our institution. Septicemia following PCNL can be catastrophic despite sterile preoperative urine and prophylactic antibiotics. Infected stones, obstructed kidneys, and comorbidity have been held responsible. In this study we analyzed various culture specimens, namely Mid-stream urine (MSU), renal pelvic urine and crushed stones. MATERIALS AND METHODS: We performed a prospective clinical study in all our patients undergoing PCNL between January 2013 and December 2014. MSU was sent for culture and sensitivity testing (C&S) one day prior to surgery. Percutaneous access into the ipsilateral pelvicaliceal system is achieved under image intensification using a fine, 14 gauge Kellet needle. Urine from the pelvicaliceal system is first aspirated and sent as pelvic urine C&S. Stone fragments are collected to be proces0sed for C&S. The data collected were divided into 3 main groups, that is MSU C&S, pelvic urine C&S and stone C&S. RESULTS: A total of 83 patients were included in the study, of this MSU C&S was positive in 9/83 (10.8%) patients, Pelvic C&S in 10 /73 (13.7%) patients and Stone C&S in 25/83 (30.1%) patients. Out of 25 cases of stone culture positive patients 17 patients developed Systemic Inflammatory Response Syndrome (SIRS) but only 2 patients developed SIRS in MSU C & S positive patients. CONCLUSIONS: The results of our study suggest that positive stone C&S is the better predictor of potential urosepsis than MSU. Stone culture is available only after surgery but appears to be the best guide for antibiotic therapy in case of sepsis. So the routine collection of stone for C&S will be beneficial.
