Clinical Significance of DJ Stent Culture in Patients with Indwelling Ureteral Stents Prior to Endourological Intervention- A Single Centre Prospective Cohort StudyCorrespondence Address :
Dr. Anoop Handa,
G-23, DLF Capital Greens, Moti Nagar, New Delhi, India.
Introduction: Ureteral Double J Stenting (DJS) is commonly done prior to endourological interventions for various indications.
Aim: To compare Urine Culture (UC) with DJ Stent Culture (SC) in patients with indwelling ureteral stents prior to endourological intervention and to evaluate the clinical significance of SC with postendourological intervention sepsis.
Materials and Methods: A prospective single centre observational study was conducted in the Department of Urology, Army Hospital Research and Referral, New Delhi, India, from August 2017 to March 2019. A total of 100 patients underwent DJS prior to definitive endourological intervention. Patient's demographic profile was recorded along with preoperative, intraoperative and postoperative parameters. UC was also recorded at these intervals along with SC. The data was analysed and compared using Statistical Package for the Social Sciences (SPSS) software.
Results: Intraoperative UC of 14 patients were colonised, SC was colonised in 11 patients. Six patients developed Urosepsis, Postoperative UC was colonised in four patients. The Sensitivity, Specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of intraoperative UC for detecting stent colonisation with identical pathogens were 63.64%, 92.13%, 50.00% and 95.35%, respectively. Patients with colonised intraoperative UC, SC cranial tip and SC caudal tip had sepsis rates of 28.6%, 50%, and 44.4%, respectively. The sensitivity and PPV of SC in predicting postoperative sepsis were low at 83.33% and 45.45%, respectively, whereas the specificity and NPV were high at 93.6% and 98.8%. A 15.8% of diabetic patients and 50% immunocompromised patients developed urosepsis. E.Coli was the commonest isolated pathogen from UC and SC. On univariate logistic regression analysis, operative time, positive intraoperative UC, positive SC were associated with postintervention sepsis. While on multivariate analysis, none of these factors were associated with postendourological intervention sepsis.
Conclusion: Performing routine SC may not be cost effective but could be recommended in cases at higher risk of developing postoperative urosepsis such as those with Diabetes Mellitus (DM) or immunocompromised patients and those expected to take longer operative time.
Colonised, Urinary infections, Urosepsis
Date of Submission: Dec 11, 2020
Date of Peer Review: Jan 11, 2021
Date of Acceptance: Feb 10, 2021
Date of Publishing: Apr 01, 2021
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Dec 17, 2020
• Manual Googling: Feb 10, 2021
• iThenticate Software: Feb 10, 2021 (21%)
ETYMOLOGY: Author Origin
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)