Methods: We performed a retrospective chart review of patients who underwent NT placement from 1/1/2005 to 12/31/2015 at Northport VA Medical Center. We identified patients with asymptomatic bacteriuria (AB) and patients who developed NT related pyelonephritis. We analyzed demographic data, medical histories, and microbiological data.
Results: 71 patients were identified with NT placement in the 10 year review. Indications for insertion: intrinsic obstruction; ureteral stone/strictures (30%), extrinsic obstruction; prostate (21%) and bladder (14%) cancers were more common. 14/71 (20%) had pyelonephritis, and 17/71 (24%) had AB. All patients were men and median age was 73. There was no difference in age between pyelonephritis and AB groups (P:0.358). In the pyelonephritis group, P.aeruginosa (36%) and Enterococcus (35%) spp were most commonly isolated. Two cases of EBSL K. pneumoniae were identified, 1 case of MDR Pseudomonas susceptible only to piperacillin/tazobactam and amikacin and 1 case of MDR Acinetobacter susceptible only to colistin and amikacin. Two patients had recurrent UTI after nephrostomy change with the same organism (S. marcescens, and ESBL Klebsiella). In the AB group P. aeruginosa (23%), Enterococcus spp (23%), coagulase negative staphylococci (23%) were most common. 1 case of ESBL K. pneumoniae was identified. There was no difference between the groups with history of diabetes (P 0.441), Cancer (P:0.157), CKD (P:0.6705), prior UTIs (P:1.000), nephrolithiasis (P: 0.067).
Conclusion: Nephrostomy tube placement carries a risk of pyelonephritis and bacteriuria. Asymptomatic bacteriuria and pyelonephritis were commonly observed in our population study. Isolation of multiple drug resistant organism was rare. Pseudomonas and Enterococcus species is most commonly isolated in both groups. The role of prophylactic antibiotics and other preventive measures needs investigation to decrease risk of NT-related pyelonephritis.
Z. Lobo, None
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