Septic shock following surgical decompression of obstructing ureteral stones: a prospective analysis
To investigate risk factors for septic shock and death in patients with obstructive pyelonephritis due to ureteral stone, who underwent urinary tract decompression.
We prospectively enrolled patients who presented at the emergency room of our institution with clinical signs of pyelonephritis, systemic inflammatory reaction syndrome (SIRS) and obstructive ureteral stone confirmed by computed tomography. Forty patients that underwent urinary tract decompression were included. Demographical, medical and laboratorial characteristics were recorded; antibiotics regimen and time from presentation to decompression were compared between patients with septic complications and patients with uneventful outcomes.
Septic shock and death occurred in 6 (15%) and 2 (5%) patients, respectively. Gender, age and co-morbidities were not associated with septic complications. Urinary culture was negative in 40% of the cohort and the most prevalent pathogen was Escherichia coli (Table 1). Administration of antibiotics other than cephalosporines was associated with septic shock (p=0.02). There was no difference between groups regarding the time of antibiotics use (p = 0.63) and time from presentation to urinary tract decompression (4.0±6.9 vs. 1.4±1.8; p=0.07; Table 2). Preoperative leucocyte count receiver operator curve for intra-operative and post-operative septic shock revealed AUC = 0.879 (p = 0.014) and AUC = 0.788 (p = 0.027), respectively (Figure 1A,B).
Time of antibiotics use and time from presentation to urinary tract decompression were not determinant to preclude patients of septic shock. Patients with elevated serum leukocytes are at substantial risk of septic shock and should undergo prompt surgical intervention.