Nephrostomy Tube Related Pyelonephritis in Patients with Cancer: Epidemiology, Infection Rate and Risk Factors
Abstract
Purpose:
Nephrostomy tube placement is often necessary to avert acute renal failure in patients with cancer with obstructive uropathy or in patients with ureteral leak. However, there have been limited published studies on the rate and risk of nephrostomy tube related pyelonephritis in patients with cancer. Therefore, in this study we determined rates of nephrostomy tube related pyelonephritis and predisposing risk factors in patients with cancer.
Materials and Methods:
We retrospectively reviewed patients who underwent nephrostomy tube placement between September 1, 2009 and September 16, 2010 at MD Anderson Cancer Center. Patients were followed for 90 days. The primary outcome assessed was the development of nephrostomy tube related pyelonephritis and the secondary outcome was the development of asymptomatic bacteriuria. We also determined risk factors associated with pyelonephritis.
Results:
Of the 200 patients analyzed 38 (19%) had pyelonephritis and 15 (7.5%) had asymptomatic bacteriuria. Of the nephrostomy tube related infections 34 cases (89%) were with the primary nephrostomy tube. Subsequently 4 of the patients who underwent nephrostomy tube exchange had an episode of pyelonephritis. Pyelonephritis developed within the first month in 19 (10%) patients. Prior urinary tract infection and neutropenia were found to be significant risk factors for pyelonephritis (p = 0.047 and 0.03, respectively).
Conclusions:
The placement of nephrostomy tubes in patients with cancer is associated with a significant rate of pyelonephritis. Neutropenia and history of urinary tract infection were significant risk factors for pyelonephritis. This finding warrants further investigation into preventive strategies to reduce the infection rate.
References
- 1 : Percutaneous nephrostomy and antegrade ureteral stenting: technique-indications-complications. Eur Radiol2006; 16: 2016. Google Scholar
- 2 : Ultrasound-guided percutaneous nephrostomy performed by urologists: 10-year experience. Urology2006; 68: 495. Google Scholar
- 3 : Single-center review of fluoroscopy-guided percutaneous nephrostomy performed by urologic surgeons. J Endourol2007; 21: 688. Google Scholar
- 4 : Complications associated with percutaneous nephrostomies: A retrospective study. Acta Radiol2004; 45: 184. Google Scholar
- 5 : Palliative percutaneous nephrostomy in recurrent cervical cancer: a retrospective analysis of 50 consecutive cases. J Pain Symptom Manage2008; 36: 185. Google Scholar
- 6 Catheter-Associated Urinary Tract Infection (CAUTI) Event. http://www.cdc.gov/nhsn/PDFs/pscManual/7pscCAUTIcurrent.pdf. Accessed August 2011. Google Scholar
- 7 : A review of radiologically guided percutaneous nephrostomies in 303 patients. J Vasc Interv Radiol1997; 8: 769. Google Scholar
- 8 : Antibiotics and nephrostomy tube care: preliminary observations: Part I. Bacteriuria. Radiology1989; 172: 1041. Google Scholar
- 9 : Antibiotics and nephrostomy tube care: preliminary observations: Part II. Bacteremia. Radiology1989; 172: 1043. Google Scholar
- 10 : Antibiotic prophylaxis in interventional radiology. J Vasc Interv Radiol2004; 15: 547. Google Scholar
- 11 : Engineering out the risk for infection with urinary catheters. Emerg Infect Dis2001; 7: 342. Google Scholar
- 12 : Risk factors for nosocomial urinary tract infection. Am J Epidemiol1986; 124: 977. Google Scholar
- 13 : Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis2004; 39: 309. Google Scholar
- 14 : Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis2009; 49: 1. Google Scholar
- 15 : Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis2011; 52: e162. Google Scholar
- 16 : Nosocomial bacteriuria: a prospective study of case clustering and antimicrobial resistance. Ann Intern Med1980; 93: 420. Google Scholar
- 17 : Catheter-associated urinary tract infections. Infect Dis Clin North Am1987; 1: 823. Google Scholar
- 18 : Long-term silicone central venous catheters impregnated with minocycline and rifampin decrease rates of catheter-related bloodstream infection in cancer patients: a prospective randomized clinical trial. J Clin Oncol2004; 22: 3163. Google Scholar
