Methods: We retrospectively reviewed patients who underwent PCN tube placement between Sep 1, 2009 and Sep 16th, 2010 at MDACC. Patients were followed for 90 days from the date of insertion of PCN tube. We collected demographic data, signs and symptoms, urine analyses and urine cultures, as well as data pertinent to the nephrostomy tube such as date of insertion, removal or exchange. PCN related infection was defined as the presence of at least one of the signs and symptoms of pyelonephritis (fever >38 oC, nausea/vomiting, flank pain, abdominal or pelvic pain, and/or costovertebral angle tenderness) associated with a positive urine culture of ≥ 105 CFU/ml or, with a urine culture of ≥103 and <105 CFU/ml along with a positive urinalysis. Asymptomatic bacteruria was defined as a urine culture > 105 CFU/ml in an aseptically collected specimen in the absence of signs and symptoms.
Results: A total of 200 patients were analyzed. 42 patients (21%) had NTRI with pyelonephritis, 17 patients (9%) had asymptomatic bacteruria. Of the PCN related infections, 22 patients (19%) had an infection with the primary PCN tube before the exchange or removal. Subsequently 8% of the patients who underwent PCN exchange had an episode of NTRI. The number of NTRI that occurred within the first month of observation was 24 patients (12%). Upon further analysis of risk factors, prior history of urinary tract infection (UTI) was found to be a significant risk factor for development of NTRI and asymptomatic bacteriuria (p=0.013).
Conclusion: Placement of PCN tubes is associated with a significant rate of NTRI. Prior history of UTI was found to be a significant risk factor for development of NTRI and bacteriuria. This warrants further investigation into preventive strategies to reduce the infection rate.
A. El Zakhem, None
K. Ahrar, None
A. M. Chaftari, None
Y. Jiang, None
R. Hachem, None
I. Raad, None