MP29-19: Bridging the Culture Gap: Do Multi-organism Stone Cultures Alter Outcomes Following PCNL?
Saturday, May 4, 2024 9:30 AM to 11:30 AM · 2 hr. (US/Central)
302B
Abstract
Information
Full Abstract and Figures
Author Block
Katya Hanessian*, Ruben Crew, Grant Sajdak, Ala'a Farkouh, Sikai Song, Kai Wen Cheng, Ruby Kuang, Akin S. Amasyali, Zhamshid Okhunov, D. Duane Baldwin, Loma Linda, CA
Introduction
Understanding the factors associated with positive stone cultures, the organism profile of the culture, and their impact on patient outcomes is crucial for kidney stone disease management. However, there is little information on whether single or multiple organisms impact outcomes. The purpose of this study was to assess the risk factors and outcomes associated with negative, single organism, and multi-organism stone cultures.
Methods
A retrospective review was performed on percutaneous nephrolithotomy (PCNL) patients with stone cultures at a single academic institution between 2017 and 2023. Data collection encompassed patient demographics, co-morbidities, laboratory findings, operative details, and postoperative outcomes. A comparative analysis was performed between negative, single organism, and multi-organism stone cultures using Chi-Square and ANOVA with Tukey B for post hoc test. Significance was defined as p<0.05.
Results
Of the 197 patients who obtained stone cultures, 86 (44%) were negative, 62 (31%) were positive for a single organism, and 49 (25%) were positive for multiple organisms. Patients with single and multi-organism stone cultures were more likely to be female (p=0.026). Patients with multi-organism stone cultures had a higher rate of preoperative Foley catheters (3% vs 5% vs 20%; p=0.001), ureteral stents (7% vs 19% vs 20%; p=0.037), and nephrostomy tubes (7% vs 15% vs 41%; p<0.001 in the negative, single, and multi-organism cultures, respectively). There was a significant difference in stone analysis based on culture (Figure 1; p<0.001). Patients with multi-organism stone cultures had longer lengths of stay (p=0.002). Single and multi-organism stone cultures were associated with postoperative fever (1% vs 11% vs 10%; p=0.025), stone recurrence (10% vs 26% vs 20%; p=0.006), and a recurrence time of less than 6 months (5% vs 11% vs 14%; p=0.005 in the negative, single, and multi-organism cultures, respectively). Most common organisms in stone cultures included Gram-negative bacilli (63.1%), Enterococci (30%), and fungi (15%).
Conclusions
Patients with multiple stone cultures were more likely to have struvite stones, had longer hospitalizations, and developed recurrence sooner. These patients may benefit from more aggressive strategies designed to minimize stone recurrence.
Source Of Funding
None
Author Block
Katya Hanessian*, Ruben Crew, Grant Sajdak, Ala'a Farkouh, Sikai Song, Kai Wen Cheng, Ruby Kuang, Akin S. Amasyali, Zhamshid Okhunov, D. Duane Baldwin, Loma Linda, CA
Introduction
Understanding the factors associated with positive stone cultures, the organism profile of the culture, and their impact on patient outcomes is crucial for kidney stone disease management. However, there is little information on whether single or multiple organisms impact outcomes. The purpose of this study was to assess the risk factors and outcomes associated with negative, single organism, and multi-organism stone cultures.
Methods
A retrospective review was performed on percutaneous nephrolithotomy (PCNL) patients with stone cultures at a single academic institution between 2017 and 2023. Data collection encompassed patient demographics, co-morbidities, laboratory findings, operative details, and postoperative outcomes. A comparative analysis was performed between negative, single organism, and multi-organism stone cultures using Chi-Square and ANOVA with Tukey B for post hoc test. Significance was defined as p<0.05.
Results
Of the 197 patients who obtained stone cultures, 86 (44%) were negative, 62 (31%) were positive for a single organism, and 49 (25%) were positive for multiple organisms. Patients with single and multi-organism stone cultures were more likely to be female (p=0.026). Patients with multi-organism stone cultures had a higher rate of preoperative Foley catheters (3% vs 5% vs 20%; p=0.001), ureteral stents (7% vs 19% vs 20%; p=0.037), and nephrostomy tubes (7% vs 15% vs 41%; p<0.001 in the negative, single, and multi-organism cultures, respectively). There was a significant difference in stone analysis based on culture (Figure 1; p<0.001). Patients with multi-organism stone cultures had longer lengths of stay (p=0.002). Single and multi-organism stone cultures were associated with postoperative fever (1% vs 11% vs 10%; p=0.025), stone recurrence (10% vs 26% vs 20%; p=0.006), and a recurrence time of less than 6 months (5% vs 11% vs 14%; p=0.005 in the negative, single, and multi-organism cultures, respectively). Most common organisms in stone cultures included Gram-negative bacilli (63.1%), Enterococci (30%), and fungi (15%).
Conclusions
Patients with multiple stone cultures were more likely to have struvite stones, had longer hospitalizations, and developed recurrence sooner. These patients may benefit from more aggressive strategies designed to minimize stone recurrence.
Source Of Funding
None