Unexpected Septic Shock after Ureteroscopic Lithotripsy in a Patient Preoperatively Treated for a Urinary Tract Infection

Background: The incidence of sepsis is increasing, especially in elderly populations with more comorbidities. It is now estimated that sepsis is a leading cause of mortality and critical illness worldwide. The Epidemiological data regarding sepsis, septic shock and organ involvement is mainly from western literature. Data from India, especially south India, are less when compared to western data. In this background authors conducted a retrospective study in tertiary care hospital in south India. Objectives of the study was epidemiology of sepsis and its various characteristics in a tertiary care adult-Multi disciplinary ICU in South India.Methods: This study was a retrospective observational study, conducted during the time period of June 2016 and May 2017. The study population was patients above 18 yrs admitted in MDICU with sepsis. The study was conducted in a tertiary care adult -Multidisciplinary ICU in South India. Various characteristics like age group, comorbidities, organ involvement, septic shock, sofa score, need for ventilatory support, RRT support and outcome data was collected.Results: In this study, 497 patients who satisfied the Surviving Sepsis Campaign guidelines were included. The majority of the patients (59.8%) were male; the majority was above 60 yr (range 18 to 92 yr). 76.3% Patients had comorbid disease. Hypertension was the most common co-morbid (62%) followed by diabetes mellitus (51.3%). Chronic Kidney Disease was found in 132 patients (26.6%) and Coronary artery disease in 121 patients (24.3%). 186 patients (46.5%) had single organ involvement 140(35%) patients had 2 organ involvement. 74(18.5%) patients had more than 2 organ involvement. Septic shock was found in 155 patients (31.2%). Renal involvement was the most common organ involvement found in 279 patients(59.9%). Most common source for sepsis was the respiratory system found in 230 patients (46.3%), followed by urinary tract infection in 117 patients (23.5%). The study shows a significant association between SOFA score and mortality (p-value 0.001) 52% of mortality happened in group of patients with SOFA score more than 15 and mortality was 28 % in group with a SOFA score of 10-15.Conclusions: In this retrospective study of sepsis, authors found that the most common source of sepsis was pneumonia (46.3%) followed by urinary tract infection (23.5%). Majority of the patients had one organ involvement (46.5%). Among the organ involvement, Acute Kidney injury was the most common organ involvement (56.1%) followed by septic shock (31.2%) and respiratory support (29.6%). Mortality in this study was higher with higher SOFA score.

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Flexible ureteroscopic lithotripsy is safe and efficient for renal stone <2 cm accompanied with persistent urinary tract infection

Journal of Integrative Nephrology and Andrology ◽

10.4103/jina.jina_1_18 ◽

2018 ◽

Vol 5 (3) ◽

pp. 100

Author(s):

Zhong Wang ◽

Jun Da ◽

Mingxi Xu ◽

Yiwei Wang ◽

Jingshen Zhang ◽

...

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Renal Stone ◽

Ureteroscopic Lithotripsy

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Possible risk factors for postoperative urinary tract infection following ureteroscopic lithotripsy

Vojnosanitetski pregled ◽

10.2298/vsp181014199j ◽

2020 ◽

Vol 77 (11) ◽

pp. 1135-1141

Author(s):

Mirko Jovanovic ◽

Vladimir Bancevic ◽

Branko Kosevic ◽

Predrag Aleksic ◽

Vesna Suljagic

Keyword(s):

Risk Factors ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Operating Time ◽

Percutaneous Nephrostomy ◽

Ureteroscopic Lithotripsy ◽

Patients With Diabetes ◽

Infection Risk Factors ◽

Jj Stent

Background/Aim. Ureteroscopic lithotripsy is today a safe method of endoscopic destruction of stone in the kidney and ureter with a small number of complications of which the most common is postoperative urinary tract infection. Risk factors for the occurrence of urinary tract infection after the ureteroscopic destruction of stones in the ureter and kidney are not clearly defined in the previous studies. Methods. The study included 389 patients with ureteroscopic lithotripsy and possible risk factors were analyzed: age of the patients, sex, diabetes presence, degree of hydronephrosis, stone size, stone localization, wear of ureteral JJ stent and percutaneous nephrostomy catheter, type of surgical procedure and duration of the operation. The frequency of postoperative urinary tract infection was statistically analyzed in relation to the possible risk factors. Results. Ten percent of the patients had postoperative urinary tract infection. The higher incidence of postoperative urinary tract infection was found in patients with diabetes (?2 = 22.918; p < 0.001), those who before surgery carried a ureteral JJ stent (?2 = 4.620; p = 0.040) and percutaneous nephrostomy catheter (?2 = 8.240; p = 0.004), who had a larger stone (?2 = -3.301; p = 0.001), and whose surgery lasted longer (t = 4.261; p < 0.001). Conclusion. The frequency of postoperative urinary infection and risk factors for its emergence in our study are in line with the results of studies by other authors. Patients with diabetes, who preoperatively carried JJ stent or a percutaneous nephrostomy catheter, who had large stones and in which the operating time is longer have a greater risk of developing postoperative urinary tract infection. Accordingly, the importance of identifying these patients in the preparation for ureteroscopic lithotripsy contributes to the appropriate preoperative preparation and decreases the frequency of postoperative urinary tract infection to a minimum.

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Postoperative urinary tract infection after ureteroscopic lithotripsy in patients with asymptomatic bacteriuria

Vojnosanitetski pregled ◽

10.2298/vsp180918163j ◽

2020 ◽

Vol 77 (9) ◽

pp. 917-922

Author(s):

Mirko Jovanovic ◽

Vesna Suljagic ◽

Vladimir Bancevic

Keyword(s):

Urinary Tract Infection ◽

Risk Factor ◽

Urinary Tract ◽

Tract Infection ◽

Urinary Infection ◽

Asymptomatic Bacteriuria ◽

Significant Risk ◽

Significant Risk Factor ◽

Ureteroscopic Lithotripsy ◽

Infective Complications

Background/Aim. Postoperative urinary tract infection (UTI) is one of the most common infective complications of ureteroscopic lithotripsy. Preoperative asymptomatic bacteriuria is not a contraindication for performing ureteroscopic lithotripsy but it can be a significant risk factor for occurrence of severe forms of postoperative urinary infection. Methods. From January 2010 until December 2014 at the Urology Clinic of the Military Medical Academy in Belgrade, 389 patients undergoing ureteroscopic lithotripsy were analyzed, and their postoperative infective complications were monitored. From the group, the incidence of posteoperative urinary infection was analysed in 52 patients with preoperative asymptomatic bacteriuria. Results. Infective complications occured in 18.7% of patients, and postoperative UTI in 10% of patients. Out of 52 patients with preoperative asymptomatic bacteriuria, 36.5% had postoperative urinary tract infection (?2 = 46.773; p < 0.001). In these patients, we registered higher frequency of severe forms of postoperative UTI, systemic inflammatory response syndrome (SIRS) and sepsis. Conclusion. Preoperative asymptomatic bacteriuria represents a significant risk factor for developing postoperative UTI following ureteroscopic lithotripsy and is associated with increased risk for occurence of severe forms of SIRS and sepsis. It is desirable that every patient with indicated ureteroscopic lithotripsy has sterile urine culture, and if this is impossible to achieve, a special caution and an adequate antibiotic therapy and prophylaxis are needed before and during the surgical procedure

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