Management of Urinary Tract Infections Associated with Nephrolithiasis

Abstract

Nephrolithiasis is a common clinical entity, and the incidence of renal stones appears to be increasing in the United States. Infection with uropathogens that produce urease can lead to the development of stones (infection stones), which serve as a continued source of recurrent infection and can lead to chronic kidney disease. Other than treating infection, medical management has little role in the treatment of infection stones; complete eradication of the stones with percutaneous nephrolithotomy or extracorporeal shock wave lithotripsy is required. Stones of metabolic origin can cause obstruction in the ureter and predispose to the development of urinary tract infection (UTI). Recognizing obstruction and initiating prompt drainage of the collecting system is important in the successful management of nephrolithiasis complicated by UTI. These patients are often at high risk of infection with an antimicrobial-resistant pathogen, so careful consideration of antimicrobial therapy is required, especially for patients who present with severe sepsis.

Clinical Practice Guidelines for the Antibiotic Treatment of Community-Acquired Urinary Tract Infections

“…are especially important causative bacteria compared with other UTIs. A UTI by urease-positive bacteria should occur in advance for infectious urinary stones (or struvite stones) or staghorn calculi to occur [ 124 125 ]. Proteus , Morganella , and Providencia spp.…”

“…Among patients with staghorn calculi, 82% are infected by urease-producing bacteria, and the most common causative bacteria in these patients are Proteus , Klebsiella , Pseudomonas , and Staphylococcus spp. [ 125 ].…”

Does mutation in gyrA and/or parC or efflux pump expression play the main role in fluoroquinolone resistance in Escherichia coli urinary tract infections?: A statistical analysis study

“…Basically, treatment is generally based on the classification of UTIs as uncomplicated or complicated according to the presence of underlying urinary tract disease [1]. In addition, especially in complicated UTI, drainage of the urinary tract should also be considered, especially in the presence of urinary tract occlusions [2]. Most UTIs require antimicrobial therapy, and drug selection should be based on the causative microorganism [3].…”

Complicaciones infecciosas asociadas a la nefrolitotomía percutánea en un hospital universitario de Colombia

“…Los factores intraoperatorios asociados al desarrollo de Respuesta Inflamatoria Sistémica post NLP son la hidronefrosis, la carga litiásica, NLP previa ipsilateral, cálculos caliceales, tipo de cálculos, múltiples trayectos de acceso, tiempo quirúrgico, la cantidad de líquido de irrigación y las transfusiones postoperatorias. [5][6][7] Aunque la fiebre aislada es relativamente frecuente después del procedimiento (21%-32,1%), la incidencia de la sepsis (0,3%-4,7%) y de choque séptico (0,3-1%) es bajo. 8,9 A pesar de que la frecuencia de complicaciones infecciosas es baja, ellas implican en un sobrecosto derivado de los tiempos de hospitalización, del uso de antibióticos y las de mayor severidad, se asocian con un alto riesgo de mortalidad.…”