Study of risk factors for urinary colonization in patients with the double J catheter

Abstract

Background The aim of this study is to evaluate the prevalence of urinary colonization in patients with the JJ stent and to define the predictive factors associated with this colonization. Methods This is a monocentric prospective study (between January 2013 and April 2017), conducted in the department of Urology B of Ibn Sina Hospital in Rabat. One hundred and forty-five double ureteral stents carried by 120 patients, 25 of which had bilateral double ureteral stent, were examined. The bacteriological profile of the urine of our patients was followed by the completion of an initial urine examination and another at the time of the removal of the JJ. The comparison of the means was made by the Student s test and the Mann–Whitney test for continuous variables and by the KHI-2 test and Fisher s test for qualitative variables. The threshold of significance is set at 0.05. Results The rate of colonization of JJ stent was 35.8% (43 out of 120). The urinary colonization rate was 31.7% (38 out of 120). Average time of indwelling of JJ stent was 90\xa0days. On double ureteral stent culture, we identified Escherichia Coli as the most predominant colonizing pathogen (47.3% of probes) followed by Enterococcus faecalis and Klebsiella pneumoniae (18.4% and 15.8%, respectively). 11.5% of colonized patients developed infectious complications (5 out of 43) and have been treated successfully except a patient who died from septic shock. In univariate analysis, diabetes mellitus ( p \u2009=\u20090.007, OR\u2009=\u20094.1, CI\u2009=\u20091.46–11.48), urgent establishment of JJ ( p \u2009=\u20090.03, OR\u2009=\u20094.61; IC\u2009=\u20091.08–19.6) and time of indwelling of the JJ ( p \u2009=\u20090.05, OR\u2009=\u20091.89, CI\u2009=\u20090.95–3.77) were the predictive factors for urinary colonization in patients with JJ. In multivariate analysis, these three factors were statistically associated with this risk: diabetes mellitus ( p \u2009=\u20090.005, OR\u2009=\u20090.23, CI\u2009=\u20090.08–0.64), the urgent establishment of JJ ( p \u2009=\u20090.05, OR\u2009=\u20090.26, CI\u2009=\u20090, 06–1.04) and time of indwelling of the JJ more than 30\xa0days ( p \u2009=\u20090.007, OR\u2009=\u20094.29, CI\u2009=\u20091.49–12.37). Conclusion The prevalence of urinary colonization in patients with the double J stent was 31.7%. Diabetes mellitus, time of indwelling of the JJ more than 30\xa0days and urgent JJ \u200b\u200b establishment are associated with a higher risk of these urinary colonizations. Strict monitoring is therefore recommended in patients with these risk factors. These results should be confirmed by multicenter and randomized studies to analyze the development of urinary tract infections in colonized patients.