MP22: What kinds of culture specimens can we expect to make a diagnosis in patients with ureteral stone and fever?
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  • 01-03,
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在輸尿管結石合併發燒的病人中, 何種檢體的細菌培養最有機會得到結果?
鄭百諭、吳維哲、鍾旭東
亞東紀念醫院 外科部 泌尿科
 
What kinds of culture specimens can we expect to make a diagnosis in patients with ureteral stone and fever?
Pai-Yu Cheng, Wei-Che Wu, Shiu-Dong Chung
Divisions of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
 
Purpose: Stone related complicated urinary tract infection(UTI) is a common reason that patients come to Emergency Department for help. Fever, chills and even sepsis may present if pyelonephritis develops. Empirical antibiotic is usually given by clinician’s experience. However, the upcoming decision of upgrade or de-escalation of antibiotic should be based on the culture report. Here, we investigated the positive rate of different culture specimens in patient with ureteral stone and fever, looking at the best method to effectively identify the organism and tailor possible treatment.
 
Materials & Methods: From Jan 2013 to Sep 2018, 93 patients with single site ureteral stone were retrospectively analyzed. All patients had fever upon admission, and all received percutaneous nephrostomy (PCN) drainage due to hydronephrosis. Urine, blood and PCN urine culture were collected in all patients before fever subsided. The patients’ characteristics, stone location and culture reports were analyzed. Cochrane’s Q test and Multivariate logistic regression were used for statistic analysis. P values less than 0.05 were considered statistically significant.
 
Results: Female was predominant in our study group, and the median age was 60 years old. Escherichia coli was the mainly identified pathogen from all three cultures, following by Klebsiella pneumoniae(Table 1). The positive rate for urine, blood and PCN urine culture was 61%, 50%, 61% respectively, but there are no significant differences among these three cultures(P=0.162). No statistical significance was noted in different culture positive rate regarding the stone location as well(Table 2). In logistic model, positive urine culture can effectively predict positive PCN culture, whereas positive blood culture cannot(Table 3).
 
Conclusion: In patients with ureteral stone and fever, urine, blood, and PCN urine cultures are equally effective to identify infection organism, with 50-60% positive rate. Positive urine culture result is correlated to positive findings from PCN urine culture, but such correlation was not found in blood culture.
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    2019-01-03 15:17:55
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    台灣泌尿科醫學會
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