Which Microbiological Specimen Best Determines Treatment for Patients with an Infected Obstructed Kidney
BAUS ePoster online library. Miller C. Jun 24, 2019; 259463; P1-4
Ms. Catherine Miller
Ms. Catherine Miller
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Abstract
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Aim
To determine the most appropriate microbiological specimen, urine culture(UC), blood culture(BC) or nephrostomy culture(NC), for guiding treatment in patients with an infected obstructed kidney receiving emergency nephrostomy placement.

METHODS

Retrospective case-note review of patients undergoing nephrostomy insertion for an infected obstructive kidney, identifying microbiological specimen analysis, antibiotic therapy and time to resolution of sepsis.

RESULTS

44 consecutive patients (12 male, 32 female; mean age 66years, range 18-93) underwent emergency nephrostomy insertion over 12 months. UC, BC and NC were taken in 75%, 72.7% and 65.9% of patients, respectively. The most commonly identified organism was E Coli. However, significant numbers of specimens (UC 77.4%, BC 42.3%, NC 53.6%) did not identify any causative organism. In only half of the patients were all three culture samples analysed, with BC revealing the greatest positivity for bacterial growth. Initial antibiotic prescription varied and was appropriate in only 13patients. A gentamicin/amoxicillin combination was subsequently found to be an appropriate regimen in more than half of the group. Resolution of sepsis took an average of 10.4days and was proportional to the number of cultures analysed (0 cultures 3.5days vs 3 cultures 14.4days). Resolution could not be attributed to solely responding to BC results but was quicker when adopting gentamicin/amoxicillin combination regimen (7.9 vs 13.6days).

Discussion
No single culture specimen was universal in providing a causative organism. However, the wider the variety of samples sent for microbiological analysis, the higher the incidence of identifying an isolate. Preliminary gentamicin/amoxicillin combination regimen is appropriate whilst awaiting culture analysis.
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