title: Systemic Inflammatory Response Syndrome Following Percutaneous Nephrolithotomy: Assessment of Risk Factors and Their Impact on Patient Outcomes.
abstract: OBJECTIVE
  To identify perioperative risk factors for postoperative systemic inflammatory response syndrome (SIRS) and suggest possible modifications to reduce morbidity.
  
  
  METHODS
  We prospectively analysed perioperative data such as history of pervious stone surgery, number and configuration of stones, presence of stent or nephrostomy, any previous positive urine culture, intraoperative renal pelvic urine and stone culture, aspiration of turbid urine on initial puncture, number of tracts required and clearance of stones, operative time and intraoperative hypotension and tachycardia of all patients who underwent percutaneous nephrolithotomy over a period of 15 months.
  
  
  RESULTS
  A total of 182 patients were included, average stone size was 2.8 cm, 36.2% had staghorn stones and 15.9% had an indwelling stent or nephrostomy. Despite sterile preoperative urine culture, renal pelvic urine culture (RPUC) was positive in 14.8% (27 patients) and stone culture was positive in 21.9% (40 patients). SIRS developed in 17.5% (32 patients) and septic shock in 1.09% (2 patients). On analysis younger age, positive RPUC and stone culture, longer operative time and intraoperative tachycardia correlated significantly with the development of SIRS.
  
  
  CONCLUSIONS
  Intra-operative cultures are only therapy-guiding cultures during SIRS, as preoperative urine cultures seldom accurately depict bacteriological status of upper tracts and thus should be obtained in all patients.
authors.affiliation: Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Prabhjot
authors.initials: P
authors.lastname: Singh
authors.forename: Siddharth
authors.initials: S
authors.lastname: Yadav
authors.forename: Animesh
authors.initials: A
authors.lastname: Singh
authors.forename: Ashish K
authors.initials: AK
authors.lastname: Saini
authors.forename: Rajeev
authors.initials: R
authors.lastname: Kumar
authors.forename: Amlesh
authors.initials: A
authors.lastname: Seth
authors.forename: Prem N
authors.initials: PN
authors.lastname: Dogra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001431:Bacteriological Techniques; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects*; D061646:Operative Time; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D017180:Tachycardia, Ventricular / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D016482:Urinalysis; D014556:Urine / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents