Clinical outcomes and complications of percutaneous nephrolithotomy (PCNL) in multidrug resistant (MDR) bacteriuria

Abstract

Objective: To evaluate the outcomes and complications of percutaneous nephrolithotomy (PCNL) in patients with multidrug resistant (MDR) urine cultures in comparison with those with normal urine cultures.

Materials and Methods: A retrospective cohort study was completed in patients who underwent PCNL at Maharaj Nakorn Chiang Mai Hospital between January, 2019 and August, 2021. The medical record charts of patients were reviewed and divided into 2 groups: those with a preoperative positive multidrug resistant culture (MDR, n=37) and those with a negative urine culture (No MDR, n=73). The following data were collected: demographics, size of stones, intraoperative data, preoperative urine cultures and postoperative complications. Association between factors and postoperative complications after PNCL were identified using a binary logistic regression model.

Results: Sepsis complications occurred in 8.2% of the patients (No MDR, n=2, MDR, n=7). The results of the multivariate analysis demonstrated a significant association between a positive preoperative MDR urine culture and postoperative sepsis complications (odds ratio (OR) = 15.21, 95%CI 1.59-145.35, p = 0.018). Conversely, female patients exhibited a decreased risk in comparison to male patients (OR 0.03, 95%CI 0.001-0.75, p = 0.003).

Conclusion: The prevalence of positive MDR bacteriuria in patients who underwent PCNL in Maharaj Nakorn Chiang Mai Hospital was relatively high. The female gender exhibited a prophylactic effect, while a positive MDR urine culture emerged as a significant risk factor for postoperative complications associated with sepsis, even in the presence of appropriately administered preoperative prophylactic antibiotics.