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Improved detection of microbial ureteral stent colonisation by sonication

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Abstract

Purpose

The diagnosis of microbial ureteral stent colonisation (MUSC) is difficult, since routine diagnostic techniques do not accurately detect microorganisms embedded in biofilms. New methods may improve diagnostic yield and understanding the pathophysiology of MUSC. The aim of the present study was to evaluate the potential of sonication in the detection of MUSC and to identify risk factors for device colonisation.

Methods

Four hundred and eight polyurethane ureteral stents of 300 consecutive patients were prospectively evaluated. Conventional urine culture (CUC) was obtained prior to stent placement and device removal. Sonication was performed to dislodge adherent microorganisms. Data of patient sex and age, indwelling time and indication for stent placement were recorded.

Results

Sonicate-fluid culture detected MUSC in 36%. Ureteral stents inserted during urinary tract infection (UTI) were more frequently colonised (59%) compared to those placed in sterile urine (26%; P < 0.001). Female sex (P < 0.001) and continuous stenting (P < 0.005) were significant risk factors for MUSC; a similar trend was observed in patients older than 50 years (P = 0.16). MUSC and indwelling time were positively correlated (P < 0.005). MUSC was accompanied by positive CUC in 36%. Most commonly isolated microorganisms were Coagulase-negative staphylococci (18.3%), Enterococci (17.9%) and Enterobacteriaceae (16.9%).

Conclusions

Sonication is a promising approach in the diagnosis of MUSC. Significant risk factors for MUSC are UTI at the time of stent insertion, female sex, continuous stenting and indwelling time. CUC is a poor predictor of MUSC. The clinical relevance of MUSC needs further evaluation to classify isolated microorganism properly as contaminants or pathogens.

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Conflict of interest statement

There is no conflict of interest.

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Authors and Affiliations

  1. Department of Urology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland

    Gernot Bonkat, Malte Rieken, Cyrill A. Rentsch, Stephen Wyler, Antje Feike, Thomas Gasser & Alexander Bachmann

  2. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland

    Andrej Trampuz & Andreas F. Widmer

  3. Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Hebelstrasse 10, 4031, Basel, Switzerland

    Juliane Schäfer

Authors
  1. Gernot Bonkat
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  2. Malte Rieken
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  3. Cyrill A. Rentsch
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  4. Stephen Wyler
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  5. Antje Feike
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  6. Juliane Schäfer
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  7. Thomas Gasser
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  8. Andrej Trampuz
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  9. Alexander Bachmann
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  10. Andreas F. Widmer
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Correspondence to Gernot Bonkat.

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Bonkat, G., Rieken, M., Rentsch, C.A. et al. Improved detection of microbial ureteral stent colonisation by sonication. World J Urol 29, 133–138 (2011). https://doi.org/10.1007/s00345-010-0535-5

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  • DOI: https://doi.org/10.1007/s00345-010-0535-5

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