Preoperative and Intraoperative Urine Cultures and its Association with Post Operative Infection after Ureteroneocystostomy
Young Son, DO1, Lance Earnshaw, MS2, Edward Wu, MS3, Kimberly Lince, MS4, Shawon Akanda, DO1, Raeann Dalton, MS5, Gregory Dean, MD6.
1Jefferson New Jersey, Philadelphia, PA, USA, 2Rocky Vista Universeity, Parker, CO, USA, 3Alabama College of Osteopathic Medicine, Dothan, AL, USA, 4University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA, 5Rowan College of Osteopathic Medicine, Stratford, NJ, USA, 6Urology for Children, Vorhees, NJ, USA.
Background: Vesicoureteral reflux (VUR) is the backflow of urine from the urinary bladder toward the kidney. Management of VUR ranges from the use of antibiotics as a prophylaxis to surgery. Patients with renal scarring or recurrent febrile UTI are candidates for ureteroneocystostomy (UNC) with success rates for both open surgeries approaching 98% and endoscopic approaching 70-90%. Investigations into the use of the preoperative and intraoperative urine culture (UCx) were assessed during a study published in 2017 suggesting little to no correlation between intra-operative UCx and postoperative infections. Our study aims to unveil the association between intra-operative urine culture and post-operative infections. We hypothesize that positive preoperative and intraoperative cultures will be correlated with postoperative UTI occurrence.
Methods: The 2020 American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP) data was analyzed for patients undergoing ureteroneocystostomy for VUR. A total of 1742 patients were evaluated with 978 meeting inclusion criteria of available preoperative or intraoperative urine culture. The patients were divided into 3 groups: no bacterial growth (Group A), bacterial growth with UTI, defined as ≥105CFU/ml with no more than 2 species of microorganism (Group B), and bacterial growth without UTI, defined as <105CFU/ml with no more than 2 species of microorganism or ≥105CFU/ml with more than 2 species of microorganism (Group C). Patient demographics, comorbid conditions, preoperative variables, and ASA classifications were evaluated (Table 1). Additionally, postoperative outcomes were evaluated between the 3 groups (Table 2). For categorical variables, Pearson chi square tests were performed, for continuous variables, mean+/-SD were presented and ANOVA analysis was performed.
Results: The postoperative urinary tract infection rate of the three groups were significant at 2.0%, 9.2%, and 9.9% for group A, B, C respectively (p<0.001). Postoperative sepsis was also noted to be 0.5%, 1.3%, and 3.6% for group A, B, C (p<0.01). Additionally, there was a difference between mean operative time (p<0.001), mean length of stay (p=0.03), and mean days from operation to discharge (p<0.01). On univariate and multivariate analysis of factors predicting for postoperative UTI, both groups B and C had higher rates compared to group A. Esophageal/gastric/intestinal disease, ostomy, neuromuscular disorder, nutritional support, total operation time, and length of stay was significant on univariate, however non-significant in multivariate analysis (Table 3).
Conclusion: Previously thought Group C was believed to be clinically insignificant. We show that there were higher rates of postoperative UTI with Group B and C compared to Group A. Considerations for treating cultures of Group B must be considered when undergoing UNC for VUR.
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