Risk factors for recurrent percutaneous nephrostomy catheter-related infections

• Published in: Infection 2019-04, Vol.47 (2), p.239-245
• Main Authors: Szvalb, Ariel D., El Haddad, Hanine, Rolston, Kenneth V., Sabir, Sharjeel H., Jiang, Ying, Raad, Issam I., Viola, George M.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Antibiotics; Antimicrobial agents; Cancer; Catheter-Related Infections - epidemiology; Catheter-Related Infections - etiology; Catheters; Chemotherapy; Demographics; Exchanging; Family Medicine; Female; General Practice; Humans; Infections; Infectious Diseases; Inpatients - statistics & numerical data; Internal Medicine; Male; Medical instruments; Medicine; Medicine & Public Health; Middle Aged; Neoplasms - therapy; Nephrostomy, Percutaneous - statistics & numerical data; Obstructions; Original Paper; Patients; Recurrence; Recurrent infection; Regression analysis; Retrospective Studies; Risk analysis; Risk Factors; Statistical analysis; Texas - epidemiology; Urinary Catheterization - adverse effects; Urinary tract; Urinary Tract Infections - epidemiology; Urinary Tract Infections - etiology; Urine; Urogenital system; Young Adult
• ISSN: 0300-8126; 1439-0973
• DOI: 10.1007/s15010-018-1245-y

Purpose Percutaneous nephrostomy (PCN) catheters are mainly indicated for urinary tract obstructions. Unfortunately, the rate for infection and recurrence remains elevated. Our objective was to identify the risk factors leading to recurrent PCN-related infections (PCNI) in cancer patients. Methods We retrospectively reviewed 571 patients who underwent initial PCN catheter placement at our institution. Of these, we identified patients with a definite PCNI and catheter exchange, with a minimum 30-day follow-up. We defined PCNI as presence of a urine culture positive for bacteria (≥ 104 CFU/mL) plus symptoms of urinary tract infection. A PCNI was considered recurrent if the same organism was isolated. Antibiotics were considered concordant if they were active against all identified organisms. Results A total of 81 patients (14%) developed an initial PCNI. Of 47 patients with 30-day follow-up, 10 patients (21%) were identified as having a recurrent PCNI. In terms of demographic characteristics, clinical manifestations, and microbiological data, there was no statistically significant difference between the recurrent and non-recurrent groups. However, in multivariate logistic regression analysis, two factors were independently associated with a decrease in recurrent PCNI: concordant antibiotic use (OR 0.04; p  = 0.008) and PCN catheter exchange within 4 days of infection (OR 0.1; p  = 0.048). Conclusions To decrease the high rate of recurrent infections, associated costs, and potential delay in further chemotherapy, we recommend that once antimicrobial susceptibility test results are available and the patient is known to be receiving concordant antimicrobials, clinicians proceed with immediate PCN catheter exchange, ideally within the first 4 days of the infection.