title: Temporal trends, practice patterns, and treatment outcomes for infected upper urinary tract stones in the United States.
abstract: BACKGROUND
  The incidence of infected urolithiasis is unknown, and evidence describing the optimal management strategy for obstruction is equivocal.
  
  
  OBJECTIVE
  To examine the trends of infected urolithiasis in the United States, the practice patterns of competing treatment modalities, and to compare adverse outcomes.
  
  
  METHODS
  A weighted estimate of 396385 adult patients hospitalized with infected urolithiasis was extracted from the Nationwide Inpatient Sample, 1999-2009.
  
  
  METHODS
  Time trend analysis examined the incidence of infected urolithiasis and associated sepsis, as well as rates of retrograde ureteral catheterization and percutaneous nephrostomy (PCN) for urgent/emergent decompression. Propensity-score matching compared the rates of adverse outcomes between approaches.
  
  
  CONCLUSIONS
  Between 1999 and 2009, the incidence of infected urolithiasis in women increased from 15.5 (95% confidence interval [CI], 15.3-15.6) to 27.6 (27.4-27.8)/100 000); men increased from 7.8 (7.7-7.9) to 12.1 (12.0-12.3)/100000. Rates of associated sepsis increased from 6.9% to 8.5% (p=0.013), and severe sepsis increased from 1.7% to 3.2% (p<0.001); mortality rates remained stable at 0.25-0.20% (p=0.150). Among those undergoing immediate decompression, 113 459 (28.6%), PCN utilization decreased from 16.1% to 11.2% (p=0.001), with significant regional variability. In matched analysis, PCN showed higher rates of sepsis (odds ratio [OR]: 1.63; 95% CI, 1.52-1.74), severe sepsis (OR: 2.28; 95% CI, 2.06-2.52), prolonged length of stay (OR: 3.18; 95% CI, 3.01-3.34), elevated hospital charges (OR: 2.71; 95%CI, 2.57-2.85), and mortality (OR: 3.14; 95%CI, 13-4.63). However, observational data preclude the assessment of timing between outcome and intervention, and disease severity.
  
  
  CONCLUSIONS
  Between 1999 and 2009, women were twice as likely to have infected urolithiasis. Rates of associated sepsis and severe sepsis increased, but mortality rates remained stable. Analysis of competing treatment strategies for immediate decompression demonstrates decreasing utilization of PCN, which showed higher rates of adverse outcomes. These findings should be viewed as preliminary and hypothesis generating, demonstrating the pressing need for further study.
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA. jsammon79@gmail.com
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Sammon
authors.forename: Khurshid R
authors.initials: KR
authors.lastname: Ghani
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Naeem
authors.initials: N
authors.lastname: Bhojani
authors.forename: Praful
authors.initials: P
authors.lastname: Ravi
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Shyam
authors.initials: S
authors.lastname: Sukumar
authors.forename: Vincent Q
authors.initials: VQ
authors.lastname: Trinh
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Kowalczyk
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kim
authors.forename: James O
authors.initials: JO
authors.lastname: Peabody
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003664:Decompression / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000639:trends*; D057216:Propensity Score; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014546:Urinary Catheterization / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D052878:Urolithiasis / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*