Risk factors for fever and sepsis after percutaneous nephrolithotomy

doi:10.1016/j.ajur.2016.03.001

Asian Journal of Urology, 2016, 3 (2): 82-87 doi: 10.1016/j.ajur.2016.03.001

Original Article

Current Issue | Archive | Adv Search

Risk factors for fever and sepsis after percutaneous nephrolithotomy

Aso Omer Rashid^a,b, Saman Salih Fakhulddin^a,b

a Department of Surgery, School of Medicine, University of Sulaimani, Sulaimani, Iraq;
b Department of Urology, Sulaimani Teaching Hospital, Sulaimani, Iraq

Abstract
Related Citation (4)

Download:

HTML

PDF (414KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective: Percutaneous nephrolithotomy (PCNL) is commonly used in the management of large renal stones. Postoperative infections are one of the most common complications of this procedure. The present study is to determine and assess the factors that may increase the risk to develop fever and urinary sepsis after PCNL.
Methods: A total of 60 patients (38 males and 22 females) with a mean age of 40.25 years enrolled in this study in Sulaimania Teaching Hospital. Patients had renal stone disease need operation with different socioeconomic status, body mass index and different type and size of stones were included in this study. Patients with preoperative positive urine culture and sensitivity were excluded. Preoperative investigations done for all patients. All Patients received prophylactic antibiotic gentamicin intravenously at the induction of anaesthesia. Renal pelvis urine sample were taken from all patients after puncturing the pelvicalyceal system and send for culture and sensitivity. Patients were monitored closely in the postoperative period for the development of fever and sepsis.
Results: Mean duration of the operations was 77.08 min ranged 40-120 min. All patients had postoperative nephrostomy tube. Seventeen (28.33%) patients developed post PCNL fever and the statistically significant factors for post PCNL fever were diabetes mellitus (DM) (p=0.001), stone burden (p=0.001), number of the stones (p < 0.001), degree of hydronephrosis (p=0.001), duration of the operation (p < 0.001), residual stones (p=0.001) and number of tracts (p=0.038). Three (5.00%) patients developed post PCNL sepsis, and the statistically significant risk factors for post PCNL sepsis were duration of the operation (p=0.013) and intraoperative blood loss, postoperative drop in haemoglobin (HB) level (p=0.046).
Conclusion: DM, staghorn stones, degree of hydronephrosis, duration of the operation and number of tracts are risk factors for post PCNL fever, while number of stones, intraoperative blood loss, duration of the operation and residual stones are risk factors for post PCNL sepsis.

Key words： Renal stones Percutaneous nephrolithotomy Urinary tract infection Fever Sepsis

Received: 01 December 2015 Published: 13 May 2016

Corresponding Authors: Aso Omer Rashid E-mail: asoomer62@hotmail.com

	Service
	E-mail this article
	Add to citation manager
	E-mail Alert
	Articles by authors
	Aso Omer Rashid
	Saman Salih Fakhulddin

TRENDMD:

Cite this article:

Aso Omer Rashid,Saman Salih Fakhulddin. Risk factors for fever and sepsis after percutaneous nephrolithotomy[J]. Asian Journal of Urology, 2016, 3(2): 82-87.

URL:

http://www.ajurology.com/EN/10.1016/j.ajur.2016.03.001 OR http://www.ajurology.com/EN/Y2016/V3/I2/82

[1]	Spernat D, Kourambas J. Urolithiasis-medical therapies. BJU Int 2011;108:9-13.
[2]	Argyropoulos AN, Tolley DA. SWL is more cost-effective than ureteroscopy and holmium:YAG laser lithotripsy for ureteric stones:a comparative analysis for tertiary referral. Br J Med Surg Urol 2010;3:65-71.
[3]	Alyami F, Skinner T, Norman R. Impact of body mass index on clinical outcomes associated with percutaneous nephrolithotomy. Can Urol Assoc J 2013;7:197-201.
[4]	Gutierrez J, Smith A, Geavlete P, Shah H, Kural A, de Sio M, et al. Urinary tract infections and post-operative fever in percutaneous nephrolithotomy. World J Urol 2012;31:1135-40.
[5]	Shin T, Cho H, Hong S, Lee J, Kim S, Hwang T. Complications of percutaneous nephrolithotomy classified by the modified Clavien grading system:a single center's experience over 16 years. Korean J Urol 2011;52:769.
[6]	Gonzalez-Ramirez A, Camarena L, Gutierrez-Aceves J. 1544 risk factors for fever and sepsis after percutaneous nephrolithotomy. J Urol 2013;189:633.
[7]	Armitage J, Irving S, Burgess N. Percutaneous nephrolithotomy in the United Kingdom:results of a prospective data registry. Eur Urol 2012;61:1188-93.
[8]	Kreydin E, Eisner B. Risk factors for sepsis after percutaneous renal stone surgery. Nat Rev Urol 2013;10:598-605.
[9]	Lojanapiwat B, Kitirattrakarn P. Role of preoperative and intraoperative factors in mediating infection complication following percutaneous nephrolithotomy. Urol Int 2011;86:448-52.
[10]	Tuzel E, Aktepe O, Akdogan B. Prospective comparative study of two protocols of antibiotic prophylaxis in percutaneous nephrolithotomy. J Endourol 2013;27:172-6.
[11]	Assimos D. Re:Urinary tract infections and post-operative fever in percutaneous nephrolithotomy. J Urol 2012;188:457.
[12]	Mariappan P, Smith G, Barisol S, Moussa S, Tolley D. Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolothotomy:a prospective clinical study. J Urol 2005; 173:1610-4.
[13]	Mariappan P, Smith G, Moussa S, Tolley D. One week of ciprofloxacin before percutaneous nephrolithotomy significantly reduces upper tract infection and urosepsis:a prospective controlled study. BJU Int 2006;98:1075-9.
[14]	Lardas M, Skolarikos A, Papatsoris A, Bourdoumis A, Athanasiadis G, Mitsogiannis I, et al. S86 antibiotic prophylaxis during PNL for staghorn stones:comparison of one-week preoperative to one-shot intraoperative antibiotic use. Eur Urol Suppl 2010;9:579.
[15]	Aghdas F, Akhavizadegan H, Aryanpoor A, Inanloo H, Karbakhsh M. Fever after percutaneous nephrolithotomy:contributing factors. Surg Infect 2006;7:367-71.
[16]	Dogan H, ?ahin A, Çetinkaya Y, Akdogan B, Özden E, Kendi S. Antibiotic prophylaxis in percutaneous nephrolithotomy:prospective study in 81 patients. J Endourol 2002;16:649-53.
[17]	Goel A, Kathpalia R, Dalela D, Mandal S, Sankhwar S, Singh V, et al. Prospective evaluation of complications using the modified Clavien grading system, and of success rates of percutaneous nephrolithotomy using Guy's Stone Score:a single-center experience. Indian J Urol 2012;28:392.
[18]	De la Rosette J, Opondo D, Daels F, Giusti G, Serrano Á, Kandasami S, et al. Categorisation of complications and validation of the Clavien score for percutaneous nephrolithotomy. Eur Urol 2012;62:246-55.
[19]	Shahrour K, Tomaszewski J, Ortiz T, Scott E, Sternberg K, Jackman S, et al. Predictors of immediate postoperative outcome of single-tract percutaneous nephrolithotomy. Urology 2012;80:19-26.