title: Urinary tract infections and post-operative fever in percutaneous nephrolithotomy.
abstract: OBJECTIVE
  To review the incidence of UTIs, post-operative fever, and risk factors for post-operative fever in PCNL patients.
  
  
  METHODS
  Between 2007 and 2009, consecutive PCNL patients were enrolled from 96 centers participating in the PCNL Global Study. Only data from patients with pre-operative urine samples and who received antibiotic prophylaxis were included. Pre-operative bladder urine culture and post-operative fever (>38.5°C) were assessed. Relationship between various patient and operative factors and occurrence of post-operative fever was assessed using logistic regression analyses.
  
  
  RESULTS
  Eight hundred and sixty-five (16.2%) patients had a positive urine culture; Escherichia coli was the most common micro-organism found in urine of the 350 patients (6.5%). Of the patients with negative pre-operative urine cultures, 8.8% developed a fever post-PCNL, in contrast to 18.2% of patients with positive urine cultures. Fever developed more often among the patients whose urine cultures consisted of Gram-negative micro-organisms (19.4-23.8%) versus those with Gram-positive micro-organisms (9.7-14.5%). Multivariate analysis indicated that a positive urine culture (odds ratio [OR] = 2.12, CI [1.69-2.65]), staghorn calculus (OR = 1.59, CI [1.28-1.96]), pre-operative nephrostomy (OR = 1.61, CI [1.19-2.17]), lower patient age (OR for each year of 0.99, CI [0.99-1.00]), and diabetes (OR = 1.38, CI [1.05-1.81]) all increased the risk of post-operative fever. Limitations include the use of fever as a predictor of systemic infection.
  
  
  CONCLUSIONS
  Approximately 10% of PCNL-treated patients developed fever in the post-operative period despite receiving antibiotic prophylaxis. Risk of post-operative fever increased in the presence of a positive urine bacterial culture, diabetes, staghorn calculi, and a pre-operative nephrostomy.
authors.affiliation: Instituto de Endourologia, Centro Medico Puerta de Hierro and Nuevo Hospital Civil, Universidad de Guadalajara, Guadalajara, Mexico.
authors.forename: Jorge
authors.initials: J
authors.lastname: Gutierrez
authors.forename: Arthur
authors.initials: A
authors.lastname: Smith
authors.forename: Petrisor
authors.initials: P
authors.lastname: Geavlete
authors.forename: Hemendra
authors.initials: H
authors.lastname: Shah
authors.forename: Ali Riza
authors.initials: AR
authors.lastname: Kural
authors.forename: Marco
authors.initials: M
authors.lastname: de Sio
authors.forename: José H
authors.initials: JH
authors.lastname: Amón Sesmero
authors.forename: András
authors.initials: A
authors.lastname: Hoznek
authors.forename: Jean
authors.initials: J
authors.lastname: de la Rosette
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications; D048909:Diabetes Complications / Q000150:complications; D004927:Escherichia coli Infections / Q000150:complications; D005260:Female; D005334:Fever / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D007669:Kidney Calculi / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D014556:Urine / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents