Comparison of the roll-plate and sonication techniques in the diagnosis of microbial ureteral stent colonisation: results of the first prospective randomised study.
BACKGROUND
Microbial ureteral stent colonisation (MUSC) is one leading risk factor for complications associated with ureteral stent placement. As MUSC remains frequently undetected by standard urine cultures, its definitive diagnosis depends on microbiological investigation of the stent. However, a standard reference laboratory technique for studying MUSC is still lacking.


METHODS
A total of 271 ureteral stents removed from 199 consecutive patients were investigated. Urine samples were obtained prior to device removal. Stents were divided into four parts. Each part was separately processed by the microbiology laboratory within 6 h. Ureteral stents were randomly allocated to roll-plate or sonication, respectively, and analysed using standard microbiological techniques. Demographic and clinical data were prospectively collected using a standard case-report form.


RESULTS
Overall, roll-plate showed a higher detection rate of MUSC compared with sonication (35 vs. 28 %, p < 0.05) and urine culture (35 vs. 8 %, p < 0.05). No inferiority of Maki's technique was observed even when stents were stratified according to indwelling time below or above 30 days. Compared with roll-plate, sonication commonly failed to detect Enterococcus spp., coagulase-negative staphylococci (CoNS) and Enterobacteriaceae. In addition, sonication required more hands-on time, more equipment and higher training than roll-plate in the laboratory.


CONCLUSIONS
This prospective randomised study demonstrates the superiority of Maki's roll-plate technique over sonication in the diagnosis of MUSC and that urine culture is less sensitive than both methods. The higher detection rate, simplicity and cost-effectiveness render roll-plate the methodology of choice for routine clinical investigation as well as basic laboratory research.
Department of Urology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland. bonkatg@uhbs.ch
G
G
Bonkat
O
O
Braissant
M
M
Rieken
G
G
Müller
R
R
Frei
Andre
A
van der Merwe
F P
FP
Siegel
T C
TC
Gasser
S
S
Wyler
A
A
Bachmann
A F
AF
Widmer
D000328:Adult; D000368:Aged; D055499:Catheter-Related Infections / Q000175:diagnosis* / Q000382:microbiology; D015169:Colony Count, Microbial; D003362:Cost-Benefit Analysis; D004755:Enterobacteriaceae / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000175:diagnosis* / Q000382:microbiology; D016983:Enterococcus / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D008297:Male; D008828:Microbiological Techniques / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013010:Sonication / Q000379:methods; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000382:microbiology; D062885:Urinary Catheters / Q000382:microbiology*; D014556:Urine / Q000382:microbiology