Clinical Scorecard: Evaluation of Preoperative versus Intraoperative Cultures in Predicting Postoperative Urinary Tract Infections After Supine Percutaneous Nephrolithotomy

At a Glance

Key Highlights

• Postoperative UTI incidence after supine PCNL was 14.1%, with postoperative fever in 12.4% and sepsis in 0.5%
• Intraoperative cultures (RPUC and SC) provide greater predictive value for postoperative infections compared to preoperative midstream urine cultures
• Female sex and higher ASA score (3) were associated with increased risk of postoperative UTI

Guideline-Based Recommendations

Diagnosis

• Obtain preoperative midstream urine culture (PMUC) for all patients undergoing PCNL
• Collect intraoperative renal pelvic urine culture (RPUC) and stone culture (SC) during PCNL for improved identification of causative pathogens

Management

• Administer antibiotic prophylaxis based on PMUC results and local antimicrobial susceptibility patterns
• For patients with positive PMUC, initiate targeted antibiotic therapy for at least seven days until sterile cultures are achieved before surgery
• Use single-dose ceftriaxone prophylaxis within 30 minutes prior to incision in patients with sterile PMUC

Monitoring & Follow-up

• Monitor postoperative patients for systemic inflammatory response syndrome (SIRS) and elevations in acute phase reactants (C-reactive protein, procalcitonin)
• Evaluate patients with signs of infection postoperatively with infectious diseases consultation for appropriate antibiotic management

Risks

• Postoperative infectious complications including fever, UTI, sepsis, and rare mortality
• Higher risk of postoperative UTI in female patients and those with ASA score of 3

Patient & Prescribing Data

Patients undergoing supine PCNL with available preoperative and intraoperative cultures

Antibiotic prophylaxis tailored to culture results reduces postoperative infection risk; intraoperative cultures guide early and effective management of postoperative infections

Clinical Best Practices

• Perform PMUC prior to PCNL and treat positive cultures with targeted antibiotics until sterile
• Collect intraoperative RPUC and SC during PCNL to improve detection of infective organisms
• Administer prophylactic antibiotics according to culture sensitivities and institutional protocols
• Closely monitor postoperative patients for signs of infection and involve infectious diseases specialists promptly
• Recognize higher infection risk in female patients and those with higher ASA scores to guide perioperative management

References

• European Association of Urology Guidelines on Urolithiasis
• Study on postoperative infections after PCNL
• Infectious complications and antibiotic prophylaxis in PCNL