Presented by: Ana Sofia Araújo MD
Hospital de Braga

Introduction

URS is one of the most used treatments for urinary stones with 9-25% post-procedure overall complications, including 15% urinary tract infections (UTI) and 5% urosepsis. In 2022, an outbreak of CPE was detected with 40-50% morbidity due to limited treatment options in this multidrug-resistant set. So, we aim to evaluate the CPE colonization in urine culture (UC) and rectal swabs (RS) before URS for urinary stones and its impact on patient morbidity.

Materials

We conducted a retrospective observational single-center study including all patients who underwent URS for urinary stones in 2022. Statistical analysis was done using IBM^®SPSS^®, version 27.0. 

Results

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A total of 381 patients were enrolled in this study, with the most prevalent comorbidity being diabetes mellitus (20.2%). Most patients didn’t have a previous indwelling urinary catheter (59.9%) and the prevalence of antibiotic treatment in the last 6 months was 50.7%, being cephalosporines the most used (44.4%). The prevalence of colonization by any bacteria in UC was 39.1% and the prevalence of RS and UC colonization by CPE was 10.5% and 16.0%, respectively. Despite that, antibiotic prophylaxis beyond perioperative was low (15.2%), and most commonly two days (6.6%). Flexible URS was the most common (60.6%) with a single stone (65.4%) and a median operative time of 24.0 minutes. 99.2% of patients had a postoperative catheter (55.1% double-J; 42.8% mono-J). Patients with CPE colonization on RS and UC were associated with 37.9% UTI with hospitalization (p<0.001, r_i=3.4), 6.9 % of bacteremia (p=0.011, r_i=4.7), and 41.4% of at least one early complication (p<0.001, r_i=3.4). Even among patients with CPE colonization on RS (but not in UC), 45.5% (r_i=2.8) had UTI with hospitalization, and 45.5% (r_i=2.4) presented with at least one complication. These results remained statistically significant even when adjusted for the previously cited confounders. Otherwise, the prevalence of UTI with hospitalization and having at least one early complication were significantly lower in patients with negative RS and UC (6.6%, ri=-3.0; 9.6% ri=-2.5, respectively).  

Conclusion

In patients who aren't colonized by CPE in either RS or UC, the risk of infectious complications after surgery or having at least one complication is similar to previous literature. However, RS colonization by CPE significantly increases these rates, highlighting the urgency of stopping this outbreak and preventing antibiotic resistance.

Funding

None

Co-Authors

Ricardo Rodrigues, MD
Hospital de Braga

Catarina Tinoco, MD
Hospital de Braga

Andreia Cardoso, MD
Hospital de Braga

Mariana Capinha, MD
Hospital de Braga

Luís Pinto, MD
Hospital de Braga

Vera Marques, MD
Hospital de Braga

Carlos Oliveira, MD
Hospital de Braga

Pedro Coelho, MD
Escola de Medicina da Universidade do Minho

Paulo Mota, MD
Hospital de Braga