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<p>Targeted preoperative antibiotic therapy can help reduce infections following percutaneous nephrolithotomy (PCNL), but it cannot eliminate them entirely, as kidney stones may serve as a reservoir for infection. Moreover, stone culture positivity (SC+) cannot be measured or treated preoperatively. If SC+ could be predicted before surgery, urologists would have an opportunity to optimize infection control of the individual patient’s risk by adjusting the duration of stone removal and managing intrarenal pressure. This was a cross-sectional study including consecutive patients with renal stones undergoing PCNL from January 2019 to August 2021. The primary outcome was SC+. Logistic regression was used to analyze independent risk factors for SC+ to develop the scale system. Internal validation of the SC+ rating scale system was conducted using bootstrapping techniques. The SC+ scale was further assessed in predicting postoperative systemic inflammatory response syndrome (SIRS) and sepsis. Totally, 1026 patients with a median age of 54 years undergoing PCNL were included. 343 (33.4%) patients were found of SC+ and 83 (8.1%) ones of postoperative sepsis. Independent risk factors for SC+ included positive preoperative urine culture (<i>P</i> &lt; 0.001), higher preoperative urine white blood cell score (<i>P</i> &lt; 0.001), positive preoperative urine nitrite (<i>P</i> &lt; 0.001), and female gender (<i>P</i> &lt; 0.001). Preoperative ipsilateral renal drainage was an independent protective factor (<i>P</i> = 0.028). These variables established an SC+ rating scale system with a robust prediction accuracy (absolute error 0.014), discrimination power (AUC 0.867) and wide net benefit range (0.070–0.920). Internal validation showed strong stability (C-index 95% CI: 0.842–0.893). Using specific cut-offs, the SC+ score effectively stratified postoperative patients into risk groups for SIRS (AUC = 0.755, OR = 0.872) and sepsis (AUC = 0.816, OR = 11.109). SC+ can be predicted by the rating scale system based on preoperative findings. An SC+ score of 11 or higher is associated with a significantly higher risk of postoperative sepsis which imply special attention and modified surgical technique.</p>

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The development and internal validation of a rating scale system in predicting renal stone bacteria culture positivity before PCNL: a cross-sectional study

  • 期刊论文

  • 发表日期：

    2026年2月16日

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  • Peng Xu,
  • Daqiang Wei,
  • Yannan Su,
  • Yuyan Zhang,
  • Qiaozhen Zhang,
  • Xiaomei Zeng,
  • Jiayi Jian,
  • Jian Weng,
  • Xiaoyu Fan,
  • Jiahui Li,
  • Bo Zhu,
  • Guohua Zeng,
  • Wenqi Wu

摘要

Targeted preoperative antibiotic therapy can help reduce infections following percutaneous nephrolithotomy (PCNL), but it cannot eliminate them entirely, as kidney stones may serve as a reservoir for infection. Moreover, stone culture positivity (SC+) cannot be measured or treated preoperatively. If SC+ could be predicted before surgery, urologists would have an opportunity to optimize infection control of the individual patient’s risk by adjusting the duration of stone removal and managing intrarenal pressure. This was a cross-sectional study including consecutive patients with renal stones undergoing PCNL from January 2019 to August 2021. The primary outcome was SC+. Logistic regression was used to analyze independent risk factors for SC+ to develop the scale system. Internal validation of the SC+ rating scale system was conducted using bootstrapping techniques. The SC+ scale was further assessed in predicting postoperative systemic inflammatory response syndrome (SIRS) and sepsis. Totally, 1026 patients with a median age of 54 years undergoing PCNL were included. 343 (33.4%) patients were found of SC+ and 83 (8.1%) ones of postoperative sepsis. Independent risk factors for SC+ included positive preoperative urine culture (P < 0.001), higher preoperative urine white blood cell score (P < 0.001), positive preoperative urine nitrite (P < 0.001), and female gender (P < 0.001). Preoperative ipsilateral renal drainage was an independent protective factor (P = 0.028). These variables established an SC+ rating scale system with a robust prediction accuracy (absolute error 0.014), discrimination power (AUC 0.867) and wide net benefit range (0.070–0.920). Internal validation showed strong stability (C-index 95% CI: 0.842–0.893). Using specific cut-offs, the SC+ score effectively stratified postoperative patients into risk groups for SIRS (AUC = 0.755, OR = 0.872) and sepsis (AUC = 0.816, OR = 11.109). SC+ can be predicted by the rating scale system based on preoperative findings. An SC+ score of 11 or higher is associated with a significantly higher risk of postoperative sepsis which imply special attention and modified surgical technique.