Is Bacterial Colonization in Ureteral Double-J Stents Significant and Is It Predictable?

Objective: Since microscopic hematuria and pyuria can be observed in patients with a ureteral double-J (DJ) stent in place, urinalysis findings are not considered significant in terms of predicting stent-related infections. This study evaluates the presence of bacterial colonization and the value/ effectiveness of urine tests in predicting the results of DJ stent cultures. Materials and Methods: In the present prospective study, we analyzed data from patients who were treated with a DJ stent placement following endourological surgery due to ureteral stones. DJ stents were removed only after the urine cultures appeared sterile or after a period of empiric antibiotic use. The relationship between urinalysis results and stent cultures was assessed. Results: A total of 65 patients (mean age, 42.6±13.5 years; 16 females and 43 males) were evaluated. Bacterial colonization was detected in 12 (18%) DJ stent cultures with Enterococcus faecalis (n=4), extended-spectrum beta-lactamase producer (ESBL (+) Escherichia coli (n=4), Corynebacterium urealyticum (n=2), candida (n=1) and methicillin-resistant Staphylococcus aureus (n=1) growth being reported. The antibiogram results of the patients that showed colonization in their cultures demonstrated penicillin (n=4), ampicillin (n=4), tetracycline (n=3), imipenem (n=2), and linezolid (n=1) sensitivity. The rate of leukocyte esterase- and nitrite-positive patients, of those having significant number of leukocytes, and urine culturepositive patients in the groups with and without positive urine culture was 58.5%, 32%, 49%, and 7.5% vs 50%, 16.6%, 50%, and 8.5%, respectively. There were no statistically significant differences between the groups (p=>0.05). None of the study patients applied to our hospital with active infection following DJ stent removal. Conclusion: Urinalysis is insufficient in predicting catheter culture results. Based on the results of this study, we assume that stent culture for removed DJ stents is not a necessity; empirical antibiotic therapy with ampicillin-tetracycline should be started in patients with postoperative infection.