Introduction and Objectives
Percutaneous nephrostomy (PCN) is widely used in urology. The aim of this study was to assess the frequency bacterial colonization of PCN, PCN-associated bacteriuria, correlation of the indwelling time with bacterial colonization and value of urine culture to identify colonizing bacteria.
Material and Methods
The prospective study was performed between 2005–2008 in 40 patients, with complete ureteric stone obstruction. PCN was inserted in all patients to releve the obstruction. All patients were treated by ESWL (Siemens Lithostar) and PCN were removed after complete stone desintegration and elimination. Sterile urine samples were taken through the nephrostomy canal after inserting and prior to removal of PCN. PCN was removed under sterile conditions and proximal (pigtail) ends were cut off and placed in the culture media for bacterial evaluation. Antibiotics were administered according to the results of positive urine samples and continued for 5–7 days and the remaining patients were treated 3 days with oral antibiotics (Olfoxacin or Cefixime). There were not patients with clinical signs of urinary tract infection and none of them were treated with antibiotics prior to PCN removal.
Bacteriuria was found in 65% and bacterial PCN colonization in 60% of patients. There was not statistically significant increase of positive urine samples taken during PCN insertion and after PCN removal (p = 0.625). Bacterial colonization was identified in (20/24) 83.3% urine samples and (4/24) 16.7% colonized PCN associated with a negative urine culture. The same colonizing microorganisms were identified in (10/24) 41.6%. The rate of colonization was 8.3%, 25% and 66.7% when indwelling time is less than 4 weeks, 4–6 weeks and more than 6 weeks, respectively. Sterile urine and colonized PCN were detected in 4/40 patients, and in 6/40 positive urine and sterile PCN were found. Positive urine and colonized PCN were detected in 20/40 and in 10/40 sterile urine and sterile PCN were found.
PCN colonization rate was 60% in our study and it is common if the indwelling time is more than 4 weeks. Bacteriuria is associated with insertions of PCN. Urine culture is the noninvasive method for detecting PCN colonization (83.3%) but it is not reliable in identifying the colonizing bacteria (only 41.6%). Prophylactic antibiotics do not prevent PCN colonization.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.