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613 BACTERIURIA IS ONLY THE SMALL MANIFESTATION OF A LARGER PROBLEM – A PROSPECTIVE COMPARATIVE STUDY OF THREE DIFFERENT METHODS FOR THE DETECTION OF MICROBIAL URETERAL STENT COLONIZATION

2010; Lippincott Williams & Wilkins; Volume: 183; Issue: 4S Linguagem: Inglês

10.1016/j.juro.2010.02.927

1527-3792

Gernot Bonkat, Malte Rieken, Cyrill A. Rentsch, Stephen Wyler, Antje Feicke, Thomas C. Gasser, Andreas F. Widmer, Alexander Bachmann,

Ureteral procedures and complications

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Kidney & Bladder1 Apr 2010613 BACTERIURIA IS ONLY THE SMALL MANIFESTATION OF A LARGER PROBLEM – A PROSPECTIVE COMPARATIVE STUDY OF THREE DIFFERENT METHODS FOR THE DETECTION OF MICROBIAL URETERAL STENT COLONIZATION Gernot Bonkat, Malte Rieken, Cyrill A. Rentsch, Stephen Wyler, Antje Feicke, Thomas C. Gasser, Andreas F. Widmer, and Alexander Bachmann Gernot BonkatGernot Bonkat More articles by this author , Malte RiekenMalte Rieken More articles by this author , Cyrill A. RentschCyrill A. Rentsch More articles by this author , Stephen WylerStephen Wyler More articles by this author , Antje FeickeAntje Feicke More articles by this author , Thomas C. GasserThomas C. Gasser More articles by this author , Andreas F. WidmerAndreas F. Widmer More articles by this author , and Alexander BachmannAlexander Bachmann More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.927AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureteral stents are frequently used in urology since minimally invasive operative and diagnostic techniques continue to flourish. Similar to other medical implants ureteral stents bear an intrinsic risk of microbial colonization and consecutive biofilm formation. Subclinical infection may be the origin of device malfunction and obstruction. More important, the colonized stent may lead to urinary tract infection and sepsis. The aim of this prospective study was to investigate the yield of three techniques for the detection of microbial ureteral stent colonization: Conventional urine culture, urine flow cytometry (UFC) and sonication. METHODS A total of 396 ureteral stents from 284 patients were included in the present study. Conventional urine cultures were obtained prior to stent removal. UFC was performed by the Sysmex UF-1000i (TOA Medical Electronics, Kobe, Japan). Sonication was conducted in an ultrasound bath to dislodge adherent bacteria. In brief, the devices were removed under aseptic conditions, placed in sterile tubes and transported immediately to the microbiology laboratory. The resulting sonicate-fluid was cultured and microorganisms identified. RESULTS Sonicate-fluid culture observed stent colonization in 35% (n=138/396). Bacteriuria - as indirect indicator for stent colonization - was detected by conventional urine culture in 15% (n= 60/396) and in 17% (n=69/396) by UFC. Positive conventional urine cultures were obtained in 37% (n=51/138) of positive sonicate-fluid cultures and in 52% (n=36/69) of cases with significant bacteriuria (UFC). The Sysmex UF-1000i detected significant bacteriuria in 37% (n=52/138) of positive sonicate-fluid cultures and 60% (n=36/60) of positive urine cultures, respectively. Compared to sonicate-fluid culture, the sensitivity and specifity of conventional urine culture (0.85 and 0.74) and UFC (0.75 and 0.78) and the positive and negative predictive values (urine culture 0.37 and 0.97, UFC 0.43 and 0.93) for the detection of stent colonization were comparable (p<0.0001). CONCLUSIONS Sonicate-fluid culture is more sensitive than conventional urine culture and urine flow cytometry in the detection of ureteral stent colonization. Since microbial ureteral stent colonization is common, prophylactic antibiotic treatment in patients scheduled for further endourologic procedures is mandatory to prevent bacterial seeding as well as subsequent infection. Basel, Switzerland© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e241 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gernot Bonkat More articles by this author Malte Rieken More articles by this author Cyrill A. Rentsch More articles by this author Stephen Wyler More articles by this author Antje Feicke More articles by this author Thomas C. Gasser More articles by this author Andreas F. Widmer More articles by this author Alexander Bachmann More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...