Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Urology, University of California San Diego, San Diego, California, USA.
J Endourol. 2024 Sep;38(9):908-915. doi: 10.1089/end.2024.0167. Epub 2024 Jun 24.
Next-generation sequencing (NGS) is a new molecular technique for identifying microorganisms. Treating bacteriuria in patients undergoing stone removal procedures is important for preventing postoperative urinary tract infection (UTI). The objective of this study is to assess the usefulness of preoperative urine NGS testing by comparing NGS with standard urine culture in predicting postoperative UTI after ureteroscopic lithotripsy (URSL) and percutaneous nephrolithotomy (PCNL). This prospective study was conducted from February 16, 2022, to January 11, 2024. Sixty subjects who underwent URSL or PCNL were included. Preoperative voided urine samples were collected for urine culture and tested by MicroGenDX for urine polymerase chain reaction (PCR) and urine NGS. Stone specimens obtained intraoperatively were also sent for stone culture and MicrogenDx. Patients were monitored for 4 weeks post-operation for recording clinical outcomes related to infections and complications. Twenty-six (43.3%) male and 34 (56.7%) female participants were included. Twenty-six (43.3%) patients underwent PCNL (15 standard PCNL and 11 mini PCNL), and 34 (56.7%) underwent URSL. Standard urine culture identified positive results in 26 cases (43.3%), PCR for 17 cases (28.3%), and NGS for 31 cases (51.7%). The overall postoperative UTI rate was 6 (10%). Standard urine culture demonstrated a sensitivity of 50%, specificity of 57.4%, and accuracy of 56.7%. Positive predictive value (PPV) was notably poor at 11.5%. Urine NGS showed a higher sensitivity of 83.3%, specificity of 53.7%, accuracy of 55%, and PPV of 16.7%. Urine NGS significantly improves the sensitivity of detecting microorganisms in preoperative urine compared with standard urine culture. Despite its high sensitivity and capability to identify nonculturable bacteria, using NGS alongside standard urine culture is recommended. This parallel approach harnesses the strengths of both methods. Integrating NGS into standard practice could elevate the quality of care, especially for patients at high risk of UTIs, such as those undergoing invasive stone removal procedures.
下一代测序（NGS）是一种新的分子技术，用于鉴定微生物。治疗接受结石清除手术的患者的菌尿症对于预防术后尿路感染（UTI）很重要。本研究的目的是通过比较 NGS 与标准尿液培养，评估术前尿液 NGS 检测在预测输尿管镜碎石术（URSL）和经皮肾镜取石术（PCNL）后 UTI 的有用性。这项前瞻性研究于 2022 年 2 月 16 日至 2024 年 1 月 11 日进行。共纳入 60 例接受 URSL 或 PCNL 的患者。采集术前排空尿液进行尿液培养，并采用 MicroGenDX 进行尿液聚合酶链反应（PCR）和尿液 NGS 检测。术中获得的结石标本也送检进行结石培养和 MicrogenDx。术后 4 周监测患者，记录与感染和并发症相关的临床结果。
纳入 26 例（43.3%）男性和 34 例（56.7%）女性患者。26 例（43.3%）患者接受 PCNL（15 例标准 PCNL 和 11 例 mini PCNL），34 例（56.7%）接受 URSL。标准尿液培养阳性结果 26 例（43.3%），PCR 阳性 17 例（28.3%），NGS 阳性 31 例（51.7%）。术后总体 UTI 发生率为 6 例（10%）。标准尿液培养的敏感性为 50%，特异性为 57.4%，准确性为 56.7%。阳性预测值（PPV）显著较差，为 11.5%。尿液 NGS 的敏感性为 83.3%，特异性为 53.7%，准确性为 55%，PPV 为 16.7%。
尿液 NGS 与标准尿液培养相比，显著提高了术前尿液中微生物的检测敏感性。尽管 NGS 具有高敏感性和识别非培养细菌的能力，但仍建议与标准尿液培养联合使用。这种平行方法利用了两种方法的优势。将 NGS 纳入标准实践可以提高护理质量，特别是对接受侵入性结石清除手术等 UTI 风险较高的患者。
