Factors predicting postoperative febrile urinary tract infection

Abstract

Background

Predictive tables and scoring systems can predict stone clearance. However, there is a paucity of evidence regarding the prediction of complications during percutaneous nephrolithotomy (PCNL), particularly in children, which remains under-researched. To our knowledge, no studies have evaluated the risk factors for febrile urinary tract infection (FUTI) after pediatric PCNL.

Objectives

To assess the predictive factors of FUTI in prepubertal children after PCNL and determine whether any prophylactic cephalosporins are superior for decreasing the FUTI rate.

Study design

Data from 1157 children who underwent PCNL between 1991 and 2012 were retrieved from the multicenter database of the Turkish Pediatric Urology Society. Children >12 years of age were excluded, leaving 830 children (364 girls, 466 boys). Data were analyzed according to the presence of FUTI and compared between the FUTI and non-FUTI groups.

Results

Mean age was 6.46 +/- 3.38 years. Twenty-nine (3.5%) children had FUTI which was confirmed by urine culture. FUTI Table Predictive factors for FUTI. occurred more frequently in young children (5.5%) than school-age children (2.4%). In univariate analysis, there were significant differences between the FUTI and non-FUTI groups regarding age, cephalosporin subgroup (first, second and third generation cephalosporin), side of PCNL, staghorn stones, tract size, operative time, postoperative ureteral catheter usage, perioperative complications (SATAVA), and blood transfusion. Multivariate analysis revealed that age, side of PCNL, staghorn stones, tract size, operative time, and blood transfusion were independent predictors of FUTI.

Discussion

The smaller tract size could cause FUTI with poor fluid drainage that may lead to elevate renal pelvic pressure and trigger bacteremia-causing pyelovenous backflow. Filling the calyx and renal pelvis by a staghorn stone and the resulting obstruction of fluid drainage may elevate intrarenal pelvis pressure. Longer operative time is likely to increase renal pelvic pressure over longer periods, which may account for FUTI after pediatric PCNL.

Conclusions

Younger age, right-sided PCNL, staghorn stones, mini-PCNL, longer operative time, and blood transfusion are risk factors for FUTI. First-, second-, and third-generation cephalosporins are equally effective for prophylaxis in prepubertal children undergoing PCNL.

C1 [Kaygisiz, Onur; Kilicarslan, Hakan] Uludag Univ, Dept Urol, Fac Med, TR-16059 Gorukle, Bursa, Turkey.

[Satar, Nihat; Izol, Volkan] Cukurova Univ, Dept Urol, Fac Med, Adana, Turkey.

[Gunes, Ali; Beytur, Ali] Inonu Univ, Dept Urol, Fac Med, Malatya, Turkey.

[Dogan, Hasan Serkan; Tekgul, Serdar] Hacettepe Univ, Dept Urol, Fac Med, Ankara, Turkey.

[Erozenci, Ahmet; Onal, Bulent] Istanbul Univ, Cerrahpasa Fac Med, Dept Urol, Istanbul, Turkey.

[Ozden, Ender; Sarikaya, Saban] Ondokuz Mayis Univ, Dept Urol, Fac Med, Samsun, Turkey.

[Piskin, Mehmet Mesut] Necmetin Erbakan Univ, Meram Fac Med, Dept Urol, Konya, Turkey.

[Demirci, Deniz] Erciyes Univ, Dept Urol, Fac Med, Kayseri, Turkey.

[Toksoz, Serdar] Baskent Univ, Dept Urol, Fac Med, Ankara, Turkey.

[Cicek, Tufan] Baskent Univ, Dept Urol, Fac Med, Konya, Turkey.

[Gurocak, Serhat] Gazi Univ, Dept Urol, Fac Med, Ankara, Turkey.

[Nazli, Oktay] Ege Univ, Dept Urol, Fac Med, Izmir, Turkey.

[Kefi, Aykut] Dokuz Eylul Univ, Dept Urol, Fac Med, Izmir, Turkey.