The following is a summary of “Obstructing Ureteral Calculi and Presumed Infection: Impact of Antimicrobial Duration and Time From Decompression to Stone Treatment in Developing Urosepsis,” published in the FEBRUARY 2023 issue of Urology by Orr, et al.

For a study, researchers sought to investigate the impact of the duration of antibiotic treatment and the timing between urgent renal decompression and stone intervention on the risk of developing urosepsis after definitive stone treatment.

A retrospective review was conducted on patients diagnosed with obstructive urolithiasis and who underwent urgent decompression with a ureteral double J stent or percutaneous nephrostomy at a single institution between 2012 and 2018. The study focused on patients with suspected infection and receiving definitive stone treatment at the same institution. Data were collected on demographic characteristics, infection and antimicrobial treatment, and initial admission to stone treatment. The association between these factors and the development of urosepsis was analyzed.

The study included 872 patients who underwent urgent renal decompression, of which 215 were included in the analysis. Among the analyzed patients, 33 had fevers, 64.2% had positive urine cultures, and 45.6% had urosepsis at the initial presentation. The median duration of antibiotic treatment post-decompression was 13 days (IQR 8-18), and the median duration from decompression to stone treatment was 17 days (IQR 12-27). Postoperative urosepsis occurred in 4.6% of patients who underwent ureteroscopy and 5% of patients who underwent percutaneous nephrolithotomy. No significant factors were associated with the development of urosepsis post-stone treatment on logistic regression analyses.

The duration of antibiotic treatment and the time between decompression and stone treatment did not affect the rates of postoperative urosepsis in patients with obstructive urolithiasis and suspected infection. Clinicians should maintain a high clinical suspicion and avoid overtreatment with antibiotics to prevent possible exacerbation of antibiotic resistance. Prospective studies are required to confirm the findings.

Reference: goldjournal.net/article/S0090-4295(22)00895-0/fulltext