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MP80-05 PREDICTORS OF SEPTIC SHOCK IN PATIENTS WITH OBSTRUCTIVE PYELONEPHRITIS DUE TO CALCULI
THE JOURNAL OF UROLOGYâ
e1020
underlie the increase in the prevalence of nephrolithiasis and contribute to the narrowing gender gap in the overall population.
Vol. 193, No. 4S, Supplement, Tuesday, May 19, 2015
MP80-05 PREDICTORS OF SEPTIC SHOCK IN PATIENTS WITH OBSTRUCTIVE PYELONEPHRITIS DUE TO CALCULI Jodi Antonelli*, Monica Morgan, Justin Friedlander, Niccolo Passoni, Adam Cohen, Daniel Mollengarten, Jeffrey Shoss, Clayton Trimmer, Sanjeeva Kalva, Yair Lotan, Margaret Pearle, Dallas, TX
Source of Funding: Dr. Furth was supported by K24DK78737 from the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases.
MP80-04 CULTURING THE RIGHT MICROORGANISMS IN PATIENTS UNDERGOING PERCUTANEOUS NEPHROLITHOTOMY (PCNL) AND FLEXIBLE URETEROSCOPY (FURS) FOR RENAL STONES e CAN WE DO ANY MORE? Rehan Khan*, Sarah Hunt, Holly Bekarma, Alison Ramsay, Sarath Krishna Nalagatla, Airdrie, United Kingdom INTRODUCTION AND OBJECTIVES: PCNL and FURS for renal stones can be a morbid procedure in view of urosepsis. Endourologists treat all positive pre-operative urine cultures with appropriate antibiotics. However, patients can still develop sepsis in the postoperative period and knowledge of the right microorganisms is not only invaluable but can also be lifesaving. Intraoperative stone cultures described as a tool to cultures the right microorganisms. Aim of this study is to assess if post op urine cultures add any information regarding culturing the right microorganisms in patients undergoing PCNL and FURS for renal stones. METHODS: We prospectively collected data for patient undergoing PCNL and FURS for renal stones in our unit between August 2013 and May 2014. Demographics, details about pre-operative urine, intra- operative stone as well as post-operative urine culture were collected. Data was analysed to assess positive culture rates in each group and specifically assessed if post op urine cultures add anything to our microbiological information. RESULTS: Data was collected for a total of 60 patients over the study period of 10 month period. Subsequently, only patients who had information available regarding pre-operative urine culture, intra-operative stone culture and postoperative urine cultures were included. This criteria led to exclusion of 19 patients and 41 patients were included in the final analysis. Mean age was 57 years with age range of 26 to 86 years. Pre-operative urine culture was positive in 13/41 patients (32). Intraoperative stone culture was positive in 8/41 patients (20%). Postoperative urine culture was positive in 6/41 patients (15%). One patient had exclusively postoperative urine culture and negative pre-operative urine and intraoperative stone culture and this correlated with postoperative sepsis. CONCLUSIONS: Our study indicates that postoperative urine cultures add to our knowledge regarding the right microorganisms in patients undergoing PCNL and FURS for kidney stones and should be carried out routinely to allow appropriate management of postoperative urinary sepsis. Source of Funding: none
INTRODUCTION AND OBJECTIVES: Obstructive pyelonephritis due to stones is a urologic emergency requiring urgent treatment. However, despite prompt intervention, some patients still do poorly. We sought to determine predictors of septic shock in patients presenting with obstructing stones and infection. METHODS: With institutional review board approval, we identified 366 patients who underwent urgent stent or nephrostomy placement for obstruction and presumed infection due to a renal or ureteral stone between December 2008 and October 2014, making this the largest infected stone series to date. The primary endpoint was development of septic shock. We performed univariate analysis (UVA) to identify factors predictive of shock. The combination of clinically relevant and statistically significant variables with the highest predictive accuracy on ROC analysis was then selected for our multivariable model. RESULTS: Among the 366 study patients, 43 (11.7%) developed septic shock after presentation. No significant differences in demographic factors were found between groups. UVA comparing parameters at presentation and time to intervention between groups are listed in Table 1. Patients who developed shock exhibited more significant abnormalities at presentation, consistent with greater severity of illness (Table 1), and received antibiotics and underwent drainage sooner than those who did not develop septic shock (Table 1). Patients with a history of chronic kidney disease were more likely while those with a history of kidney stones were less likely to develop shock (Table 1). As shown in Table 1 we constructed a multivariable model using serum creatinine, white blood cell count, heart rate, and stone history which was highly predictive of septic shock risk (AUC¼ 0.812). CONCLUSIONS: Combining presenting serum creatinine and white count, heart rate, and stone history was highly predictive of shock risk. Identifying high risk patients for closer monitoring and a lower threshold for ICU admission may allow us to impact their outcomes. No Septic Shock (n¼ 323)
Septic Shock (n¼ 43)
Temperature (C)
37.1 (36.5, 38.3)
37.9 (36.9, 38.8)
p-value 0.003
MAP (mmHg)
97.0 (86.0, 108.0)
87.0 (75.0, 100.0)
0.003
Heart rate (beats/min)
96.0 (83.0, 111.0)
117.0 (97.0, 135.0)
<0.0001
WBC (cells/mm)
13.1 (10.3, 16.3)
15.4 (12.3, 20.5)
0.002
Serum glucose
117 (101, 141)
127 (113, 180)
0.008
Serum creatinine
0.9 (0.7, 1.2)
1.2 (0.8, 1.8)
0.001
Nitrite positive (%)
43
40
0.70
LE positive (%)
90
95
0.30
History of CKD (%)
7
26
<0.0001
Diabetes (%)
17
28
0.094
Recurrent stone (%)
49
28
0.008
Time to abx (hours)
4.8 (2.9, 8.1)
3.3 (1.7, 6.2)
0.006
Time to drain (hours)
13.1 (7.8, 24.0)
8.6 (6.8, 17.8)
0.025
Time CT to drain (hrs)
10.5 (5.7, 20.3)
6.6 (3.8, 12.3)
Multivariable Model
OR
0.011
95% CI
p-value 0.007
Serum creatinine
1.59
1.13, 2.24
WBC (cells/mm)
1.04
0.98, 1.10
0.2
Heart rate (beats/min)
1.04
1.03, 1.06
<0.0001
Recurrent stone (%)
0.35
0.16, 0.75
0.007
Results for continuous variables are presented as median (25th to 75th percentile).
Source of Funding: None
e1020
underlie the increase in the prevalence of nephrolithiasis and contribute to the narrowing gender gap in the overall population.
Vol. 193, No. 4S, Supplement, Tuesday, May 19, 2015
MP80-05 PREDICTORS OF SEPTIC SHOCK IN PATIENTS WITH OBSTRUCTIVE PYELONEPHRITIS DUE TO CALCULI Jodi Antonelli*, Monica Morgan, Justin Friedlander, Niccolo Passoni, Adam Cohen, Daniel Mollengarten, Jeffrey Shoss, Clayton Trimmer, Sanjeeva Kalva, Yair Lotan, Margaret Pearle, Dallas, TX
Source of Funding: Dr. Furth was supported by K24DK78737 from the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases.
MP80-04 CULTURING THE RIGHT MICROORGANISMS IN PATIENTS UNDERGOING PERCUTANEOUS NEPHROLITHOTOMY (PCNL) AND FLEXIBLE URETEROSCOPY (FURS) FOR RENAL STONES e CAN WE DO ANY MORE? Rehan Khan*, Sarah Hunt, Holly Bekarma, Alison Ramsay, Sarath Krishna Nalagatla, Airdrie, United Kingdom INTRODUCTION AND OBJECTIVES: PCNL and FURS for renal stones can be a morbid procedure in view of urosepsis. Endourologists treat all positive pre-operative urine cultures with appropriate antibiotics. However, patients can still develop sepsis in the postoperative period and knowledge of the right microorganisms is not only invaluable but can also be lifesaving. Intraoperative stone cultures described as a tool to cultures the right microorganisms. Aim of this study is to assess if post op urine cultures add any information regarding culturing the right microorganisms in patients undergoing PCNL and FURS for renal stones. METHODS: We prospectively collected data for patient undergoing PCNL and FURS for renal stones in our unit between August 2013 and May 2014. Demographics, details about pre-operative urine, intra- operative stone as well as post-operative urine culture were collected. Data was analysed to assess positive culture rates in each group and specifically assessed if post op urine cultures add anything to our microbiological information. RESULTS: Data was collected for a total of 60 patients over the study period of 10 month period. Subsequently, only patients who had information available regarding pre-operative urine culture, intra-operative stone culture and postoperative urine cultures were included. This criteria led to exclusion of 19 patients and 41 patients were included in the final analysis. Mean age was 57 years with age range of 26 to 86 years. Pre-operative urine culture was positive in 13/41 patients (32). Intraoperative stone culture was positive in 8/41 patients (20%). Postoperative urine culture was positive in 6/41 patients (15%). One patient had exclusively postoperative urine culture and negative pre-operative urine and intraoperative stone culture and this correlated with postoperative sepsis. CONCLUSIONS: Our study indicates that postoperative urine cultures add to our knowledge regarding the right microorganisms in patients undergoing PCNL and FURS for kidney stones and should be carried out routinely to allow appropriate management of postoperative urinary sepsis. Source of Funding: none
INTRODUCTION AND OBJECTIVES: Obstructive pyelonephritis due to stones is a urologic emergency requiring urgent treatment. However, despite prompt intervention, some patients still do poorly. We sought to determine predictors of septic shock in patients presenting with obstructing stones and infection. METHODS: With institutional review board approval, we identified 366 patients who underwent urgent stent or nephrostomy placement for obstruction and presumed infection due to a renal or ureteral stone between December 2008 and October 2014, making this the largest infected stone series to date. The primary endpoint was development of septic shock. We performed univariate analysis (UVA) to identify factors predictive of shock. The combination of clinically relevant and statistically significant variables with the highest predictive accuracy on ROC analysis was then selected for our multivariable model. RESULTS: Among the 366 study patients, 43 (11.7%) developed septic shock after presentation. No significant differences in demographic factors were found between groups. UVA comparing parameters at presentation and time to intervention between groups are listed in Table 1. Patients who developed shock exhibited more significant abnormalities at presentation, consistent with greater severity of illness (Table 1), and received antibiotics and underwent drainage sooner than those who did not develop septic shock (Table 1). Patients with a history of chronic kidney disease were more likely while those with a history of kidney stones were less likely to develop shock (Table 1). As shown in Table 1 we constructed a multivariable model using serum creatinine, white blood cell count, heart rate, and stone history which was highly predictive of septic shock risk (AUC¼ 0.812). CONCLUSIONS: Combining presenting serum creatinine and white count, heart rate, and stone history was highly predictive of shock risk. Identifying high risk patients for closer monitoring and a lower threshold for ICU admission may allow us to impact their outcomes. No Septic Shock (n¼ 323)
Septic Shock (n¼ 43)
Temperature (C)
37.1 (36.5, 38.3)
37.9 (36.9, 38.8)
p-value 0.003
MAP (mmHg)
97.0 (86.0, 108.0)
87.0 (75.0, 100.0)
0.003
Heart rate (beats/min)
96.0 (83.0, 111.0)
117.0 (97.0, 135.0)
<0.0001
WBC (cells/mm)
13.1 (10.3, 16.3)
15.4 (12.3, 20.5)
0.002
Serum glucose
117 (101, 141)
127 (113, 180)
0.008
Serum creatinine
0.9 (0.7, 1.2)
1.2 (0.8, 1.8)
0.001
Nitrite positive (%)
43
40
0.70
LE positive (%)
90
95
0.30
History of CKD (%)
7
26
<0.0001
Diabetes (%)
17
28
0.094
Recurrent stone (%)
49
28
0.008
Time to abx (hours)
4.8 (2.9, 8.1)
3.3 (1.7, 6.2)
0.006
Time to drain (hours)
13.1 (7.8, 24.0)
8.6 (6.8, 17.8)
0.025
Time CT to drain (hrs)
10.5 (5.7, 20.3)
6.6 (3.8, 12.3)
Multivariable Model
OR
0.011
95% CI
p-value 0.007
Serum creatinine
1.59
1.13, 2.24
WBC (cells/mm)
1.04
0.98, 1.10
0.2
Heart rate (beats/min)
1.04
1.03, 1.06
<0.0001
Recurrent stone (%)
0.35
0.16, 0.75
0.007
Results for continuous variables are presented as median (25th to 75th percentile).
Source of Funding: None