Schuil Hugo W, van de Kamp J, de Weijer T R, van Elzakker E P M, Baard J, Bouma-Houwert A C, Henderickx M M E L, Goossens-Laan C A, van der Spruit J A, van Moorselaar R J A, Beerlage H P, Schout B M A, Kamphuis G M
Department of Urology, Amsterdam UMC, University of Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands.
Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
World J Urol. 2025 Jun 25;43(1):393. doi: 10.1007/s00345-025-05772-5.
The study investigates the results of kidney stone cultures and its correlation with preoperative urine tests, stone composition and postoperative systemic inflammatory response syndrome (SIRS) in patients undergoing percutaneous nephrolithotomy (PCNL).
Data from 338 PCNL procedures performed between January 2018 and September 2023 at two centers in the Netherlands were included for analysis. Preoperative urine tests, kidney stone analysis and the outcome of kidney stone cultures were evaluated in addition to general patient characteristics and surgical information. Preoperative urine tests and stone cultures were concordant if they were both negative or both positive with the same microorganism. Multivariable logistic regression evaluated factors associated with positive stone cultures and their relationship to postoperative SIRS.
Stone cultures were positive in 43% of cases and were concordant with preoperative urine tests in 66% of cases. Stone culture results identified 33 different microorganisms, extending beyond urease-positive bacteria: most commonly found were Enterococcus faecalis, Escherichia coli, and Proteus mirabilis. Positive stone cultures were found across all types of stone composition. Positive stone cultures were significantly associated with postoperative SIRS (OR 3.12, 95% CI 1.01-9.65) and a positive preoperative urine test was not (OR 1.60, 95% CI 0.56-4.53).
Stone cultures provide additional microbiological insights to preoperative urine testing. All types of stone composition can be associated with positive stone cultures, questioning the current thinking of infection vs. non-infection stones.
本研究调查经皮肾镜取石术（PCNL）患者肾结石培养结果及其与术前尿液检查、结石成分和术后全身炎症反应综合征（SIRS）的相关性。
纳入2018年1月至2023年9月在荷兰两个中心进行的338例PCNL手术的数据进行分析。除了一般患者特征和手术信息外，还评估了术前尿液检查、肾结石分析和肾结石培养结果。如果术前尿液检查和结石培养均为阴性或均为同一微生物阳性，则两者结果一致。多变量逻辑回归评估与结石培养阳性相关的因素及其与术后SIRS的关系。
43%的病例结石培养呈阳性，66%的病例与术前尿液检查结果一致。结石培养结果鉴定出33种不同的微生物，超出了尿素酶阳性细菌的范围：最常见的是粪肠球菌、大肠埃希菌和奇异变形杆菌。在所有类型的结石成分中均发现结石培养阳性。结石培养阳性与术后SIRS显著相关（OR 3.12，95%CI 1.01-9.65），而术前尿液检查阳性则无此关联（OR 1.60，95%CI 0.56-4.53）。
结石培养为术前尿液检查提供了额外的微生物学见解。所有类型的结石成分都可能与结石培养阳性有关，这对目前关于感染性结石与非感染性结石的观点提出了质疑。
