MP32-10 DEFINING a BACTERIAL "BE ON THE LOOKOUT" FOR URETHROPLASTY

You have accessJournal of UrologyReconstruction: Urethral Reconstruction (Including Stricture) II (MP32)1 May 2024MP32-10 DEFINING a BACTERIAL "BE ON THE LOOKOUT" FOR URETHROPLASTY Carlos I. Calvo, Ryan Noble, Nathan Y. Hoy, and Keith F. Rourke Carlos I. CalvoCarlos I. Calvo , Ryan NobleRyan Noble , Nathan Y. HoyNathan Y. Hoy , and Keith F. RourkeKeith F. Rourke View All Author Informationhttps://doi.org/10.1097/01.JU.0001008816.80828.35.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pre-operative bacteriuria has been found to be independently associated with 90-day complications after urethroplasty. However, it remains unclear which specific micro-organisms are the primary drivers of this morbidity. The objective of this study is to determine which bacteria surgeons should "be on the lookout" (BOLO) for by identifying which specific bacteria are associated with increased risk of 90-day complications after urethroplasty. METHODS: A single-institution, 2-surgeon retrospective review was performed on patients undergoing urethroplasty from August 2003-June 2020. Variables included the incidence, type and Clavien-Dindo grade of complications, patient age, comorbidities, Charlson Comorbidity Index (CCI), smoking status, obesity, type of urethroplasty, stricture etiology, length, location, prior endoscopic procedures, previous urethroplasty, preoperative suprapubic catheterization and bacteriuria. The latter was considered significant when the patient had either a mixed culture with ≥108CFU/l or an identifiable microorganism with ≥106CFU/l. The primary outcome was the incidence of 90-day complications defined as Clavien grade≥2. Descriptive statistics were used to summarize the results and Chi-square was used to determine if the presence of a specific bacterium was associated with 90-day complications. RESULTS: Of the 1,611 patients included in the analysis, 23.2% (373/1611) had clinically significant pre-operative bacteriuria. The most common pathogens on urine culture included coagulase negative staphylococcus 18.5 % (69), mixed growth 15.8% (59), E. Coli 10.7% (40) and Enterococcus 14.2% (53). Overall, 7.9% (128/1611) experienced a significant 90-day complication (Clavien≥2) with a higher rate of complications for those with pre-operative bacteriuria (10.5% vs. 7.2%; p=0.04). Gram negative bacilli including E. Coli, Pseudomonas sp., Klebsiella sp., Serratia sp., Citrobacter sp., Achromobacter sp., Stenotrophomonas sp. and Morganella sp. were associated with higher rates of post-operative complications (14.2%; p=0.01) as well as Enterococcus sp. (15.1%; p=0.03). However, gram positive cocci (10.4%; p=0.23), gram positive bacilli (11.8%; p=0.47), mixed growth (5.1%; p=0.54) and Candida (20.0%; p=0.27) were not. Neither escalating concentrations of bacteria on culture (p=0.44) or number of bacterial strains (p=0.08) were associated with a higher rate of complications. CONCLUSIONS: While pre-operative bacteriuria is associated with higher rates of 90-day complications, the main driver of these complications is gram negative bacilli and Enterococcus sp. Patients with pre-operative bacteriuria related to gram positive cocci, gram positive bacilli, and mixed growth can likely proceed with urethroplasty with appropriate infection prophylaxis without increased risk of post-operative complications. Source of Funding: Not applicable © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e518 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Carlos I. Calvo More articles by this author Ryan Noble More articles by this author Nathan Y. Hoy More articles by this author Keith F. Rourke More articles by this author Expand All Advertisement PDF downloadLoading ...