Evaluation of Urosepsis and Bacteriuria in Patients Undergoing PCNL and URS

Bivash Boran Biswas(1), Mousumi Malakar(2), Sazzad Bin Shahid(3), Sayem Hossain(4), Khan NazrulIslam(5), SA Anwarul Quadir(6)

(1)Assistant Professor, Department of Urology, Dhaka Medical College, Dhaka, Bangladesh; (2)Registrar, Department of ENT, Medical College of Woman & Hospital. Uttara, Dhaka, Bangladesh; (3)Associate Professor, Department of Microbiology, Dhaka Medical College, Dhaka, Bangladesh; (4)IndoorMedical Officer(IMO), Department of Urology, Dhaka Medical College, Dhaka, Bangladesh; (5)Assistant Professor, Dept. Of Urology, National Institute of Kidney Diseases & Urology (NIKDU), Dhaka, Bangladesh; (6)Assistant Professor, Dept. Of Urology, National Institute of Kidney Diseases & Urology (NIKDU), Dhaka, Bangladesh
Email Address: bivashboran@gmail.com

Urosepsis usually develops from a community or nosocomial acquiredurinary tract infection (UTI) or during the procedure of various urinarydisease such ureterorenoscopy (URS) and percutaneousnephrolithotomy (PCNL). Urosepsis is associated with bacteriuria,Urosepsis due to manipulation during or after percuteneousnephrolithotomy (PCNL) or ureterorenoscopy (URS) or push bangstenting can be catastrophic despite prophylactie antibiotic coverage.This cross sectional study was carried out in Dhaka Medical CollegeHospital, Dhaka, Bangladesh during the period of July 2011 to June 2013. Sampling techniquewas purposive and sample size was 70. Among them 23 patients forPCNL and 47 patients for URS were selected by selection criteria.Data were collected by interview of the patients, clinical examinationsand laboratory investigations usingthe research instrument. Data wereprocessed and analyzed using software SPSS (Statistical Package forSocial Sciences) version 11.5.Incidence of bacteriuria and urosepsis were measured according to urineand blood culture report. Sensitivity pattern wasalso observed.According to this study, the incidence of bacteriuria and urosepsis were17.1% and 5.7% respectively,Of the 70 patients, 12(17.1%) exhibited bacterial growth on urine culture,These 12 patients were then subjected to blood culture and 4(33.3%) ofthem were found positive. Most (83.4%) of the urine and blood infections(75%) were caused by E. coli. Some widely used antibiotics like moxicillin, Cephalexin and Ciprofloxacin were found 100% resistant inurine culture. Few sensitive antibiotics were Tobramycin (100 %),Amikacin and Ceftazidime (75%). Almost same sensitivity pattern wasfound in blood culture.In urosepsis, as in other types of sepsis. Urosepsis after PCNL and URSis an important and potentially catastrophic complication. Percuteneousnephrolithotomy (PCNL), Ureterorenoscopy (URS) occurs frequently inthis institution. Although the incidence of urosepsis and bacteriuria withresistant organism is low, but it is a burning issue in management inurology practice. The apparent increase in ciprofloxacin resistantorganisms appears to be associated with the increased rate ofciprofloxacin resistant organisms are observed in the general population.