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RMJ. 2019; 44(4): 737-739


Positive stone culture and its association with urosepsis after endoscopic stone surgery

Nisar Ahmed Shaikh, Aamir Ali Shaikh, Ghulam Shabir Shaikh, Sajid Ali Abbasi, Akbar Ali Soomro, Malik Hussain Jalbani, Abdul Hussain Shar.

Abstract
Objective: To determine the frequency of systemic inflammatory response syndrome and urosepsis after endoscopic stone surgery and to observe the stone culture and sensitivity pattern in stone disease patients.
Methodology: The study included 187 patients undergoing endoscopic surgery having negative midstream urine culture and sensitivity testing (C&S). During surgery, small fragmented stones were obtained and sent for stone C&S. Post operatively, patients were evaluated for systemic inflammatory response and urosepsis.
Results: Out of 187 patient’s, 39(20.85%) were positive. Among them 39 patients, 29(74.35%) were male 10(25.64%) female. We found 4 cases, out of 10 PCNL were positive stone C&S(40%), while 12 URS cases were positive stone C/S out of 37 (32.4%) and 23 cases of Litholapaxy 23 were positive stone C&S out of 140 (16.42%), respectively. The common organisms were E. coli 30 (76.92%), Klebsilla 4(10.24%), Proteus 3(7.69%) and Staph coagulase –ve 3(7.69%). SIRS developed in 9(4.812%) patients and urosepsis in 2(1.069%) in 187 patients, while SIRS developed in 9(23.07%) and urosepsis 2(5.12%) patients among stone C/S positive patients. Resistance was seen in Quniolone (52%), Cephlosporin (62%), Gentamycin (58%), B-lactamase (32%) and Pencillin (70%), respectively. Sensitivity was seen in Amikacin (85%), Nitrofuradantin (90%), Fosfomycin (95%), pipracillin/Tazobactum (97%) and Meronam (98%), respectively.
Conclusions: Positive stone C&S is better predictors for SIRS and urosepsis. Therefore, routine collection of stone fragments for C&S is recommended after endoscopic stone surgery.

Key words: Urolithiasis, stone culture and sensitivity, SIRS, urosepsis.



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