The impact of nephrostomy drainage prior to mini-percutaneous nephrolithotomy in patients with ESBL-positive Escherichia coli



Extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) is one of the most frightening multidrug-resistant bacteria that usually causes sepsis. Herein we explored the benefits of nephrostomy drainage prior to percutaneous nephrolithotomy (PCNL) on infection outcomes in patients with ESBL-EC.

Patients and methods

Between June 2016 and April 2019, 43 consecutive patients with ESBL-EC who received nephrostomy drainage for > 24 h prior to PCNL were retrospectively evaluated as group 1. 86 patients were randomly selected from patients with ESBL-EC who received concurrent percutaneous access during PCNL as group 2. The postoperative infection complications were compared.


Although the total infection complications were not statistically different (11.6% vs. 25.6%, p = 0.066), the severity seemed to be worse among group 2 subjects. Severe infections, including urosepsis (4.7% vs.13.9%) and septic shock (2.3% vs 4.6%), were observed at twice or greater rates in group 2. Blood transfusions were also more frequent (2.3% vs. 13.9%, p = 0.039). Multivariate analysis demonstrated that preoperative drainage was an independent risk factor for postoperative infection events (OR 2.31 CI 1.14–3.48, p = 0.017). Subgroup analyses indicated that preoperative drainage may largely reduce the incidence of urosepsis in patients with hydronephrosis or without receiving preoperative carbapenem therapy.


Because of the high rate of severe infection after PCNL in patients with ESBL‑positive E. coli, preoperative nephrostomy drainage for > 24 h is an effective measure to reduce the risk of severe infection complications, especially in patients with hydronephrosis or those without preoperative carbapenem therapy.

This is a preview of subscription content, access via your institution.


  1. 1.

    Koras O, Bozkurt IH, Yonguc T et al (2015) Risk factors for postoperative infectious complications following percutaneous nephrolithotomy: a prospective clinical study. Urolithiasis 43:55–60.

    Article  PubMed  Google Scholar 

  2. 2.

    de la Rosette J, Assimos D, Desai M et al (2011) The clinical research office of the endourological society percutaneous nephrolithotomy global study: indications, complications, and outcomes in 5803 patients. J Endourol 25:11–17.

    Article  PubMed  Google Scholar 

  3. 3.

    Sfeir MM, Askin G, Christos P (2018) Beta-lactam/beta-lactamase inhibitors versus carbapenem for bloodstream infections due to extended-spectrum beta-lactamase-producing Enterobacteriaceae: systematic review and meta-analysis. Int J Antimicrob Agents 52:554–570.

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Ozden E, Bostanci Y, Yakupoglu KY et al (2009) Incidence of acute prostatitis caused by extended-spectrum beta-lactamase-producing Escherichia coli after transrectal prostate biopsy. Urology 74:119–123.

    Article  PubMed  Google Scholar 

  5. 5.

    Picozzi SCM, Casellato S, Rossini M et al (2014) Extended-spectrum beta-lactamase-positive Escherichia coli causing complicated upper urinary tract infection: urologist should act in time. Urol Ann 6:107–112.

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Benson AD, Juliano TM, Miller NL (2014) Infectious outcomes of nephrostomy drainage before percutaneous nephrolithotomy compared to concurrent access. J Urol 192:770–774.

    Article  PubMed  Google Scholar 

  7. 7.

    Bearelly P, Lis C, Trussler J et al (2018) Nephrostomy tube placement prior to percutaneous nephrolithotomy does not impact outcomes. Can J Urol 25:9497–9502

    PubMed  Google Scholar 

  8. 8.

    Singer M, Deutschman CS, Seymour CW et al (2016) The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 315:801–810.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Tefekli A, Ali Karadag M, Tepeler K et al (2008) Classification of percutaneous nephrolithotomy complications using the modified Clavien grading system: looking for a standard. Eur Urol 53:184–190.

    Article  PubMed  Google Scholar 

  10. 10.

    Lai WS, Assimos D (2018) Factors associated with postoperative infection after percutaneous nephrolithotomy. Rev Urol 20:7–11.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Patel N, Shi W, Liss M et al (2015) Multidrug resistant bacteriuria before percutaneous nephrolithotomy predicts for postoperative infectious complications. J Endourol 29:531–536.

    Article  PubMed  Google Scholar 

  12. 12.

    Ben-Ami R, Rodríguez-Baño J, Arslan H et al (2009) A multinational survey of risk factors for infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae in nonhospitalized patients. Clin Infect Dis 49:682–690.

    Article  PubMed  Google Scholar 

  13. 13.

    Schwaber MJ, Carmeli Y (2007) Mortality and delay in effective therapy associated with extended-spectrum beta-lactamase production in Enterobacteriaceae bacteraemia: a systematic review and meta-analysis. J Antimicrob Chemother 60:913–920.

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Cantón R, Novais A, Valverde A et al (2008) Prevalence and spread of extended-spectrum beta-lactamase-producing Enterobacteriaceae in Europe. Clin Microbiol Infect 14(Suppl 1):144–153.

    Article  PubMed  Google Scholar 

  15. 15.

    Pitout JDD, Laupland KB (2008) Extended-spectrum beta-lactamase-producing Enterobacteriaceae: an emerging public-health concern. Lancet Infect Dis 8:159–166.

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Harris PNA, Tambyah PA, Lye DC et al (2018) Effect of piperacillin–tazobactam vs meropenem on 30-day mortality for patients with E. coli or Klebsiella pneumoniae bloodstream infection and ceftriaxone resistance: a randomized clinical trial. JAMA 320:984–994.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Tamma PD, Rodriguez-Bano J (2017) The use of noncarbapenem β-lactams for the treatment of extended-spectrum β-lactamase infections. Clin Infect Dis 64:972–980.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Tamma PD, Han JH, Rock C et al (2015) Carbapenem therapy is associated with improved survival compared with piperacillin–tazobactam for patients with extended-spectrum β-lactamase bacteremia. Clin Infect Dis 60:1319–1325.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Benanti GE, Brown ART, Shigle TL et al (2019) Carbapenem versus cefepime or piperacillin–tazobactam for empiric treatment of bacteremia due to extended-spectrum-β-lactamase-producing Escherichia coli in patients with hematologic malignancy. Antimicrob Agents Chemother 63(2):e01813–e01818.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Goldsmith ZG, Oredein-McCoy O, Gerber L et al (2013) Emergent ureteric stent vs percutaneous nephrostomy for obstructive urolithiasis with sepsis: patterns of use and outcomes from a 15-year experience. BJU Int 112:E122–128.

    Article  PubMed  Google Scholar 

  21. 21.

    ElSheemy MS, Shouman AM, Shoukry AI et al (2015) Ureteric stents vs percutaneous nephrostomy for initial urinary drainage in children with obstructive anuria and acute renal failure due to ureteric calculi: a prospective, randomised study. BJU Int 115:473–479.

    Article  PubMed  Google Scholar 

  22. 22.

    Aron M, Goel R, Gupta NP, Seth A (2005) Incidental detection of purulent fluid in kidney at percutaneous nephrolithotomy for branched renal calculi. J Endourol 19:136–139.

    Article  PubMed  Google Scholar 

  23. 23.

    Eswara JR, Lee H, Dretler SP, Sacco D (2013) The effect of delayed percutaneous nephrolithotomy on the risk of bacteremia and sepsis in patients with neuromuscular disorders. World J Urol 31:1611–1615.

    Article  PubMed  Google Scholar 

  24. 24.

    Willems SA, Kranenburg FJ, Le Cessie S et al (2019) Variation in red cell transfusion practice in the intensive care unit—an international survey. J Crit Care 55:140–144.

    Article  PubMed  Google Scholar 

  25. 25.

    Russell L, Holst LB, Lange T et al (2018) Effects of anemia and blood transfusion on clot formation and platelet function in patients with septic shock: a substudy of the randomized TRISS trial. Transfusion 58:2807–2818.

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Chan Y-L, Han S-T, Li C-H et al (2017) Transfusion of red blood cells to patients with sepsis. Int J Mol Sci 18(9):1946.

    CAS  Article  PubMed Central  Google Scholar 

  27. 27.

    Hirano Y, Miyoshi Y, Kondo Y et al (2019) Liberal versus restrictive red blood cell transfusion strategy in sepsis or septic shock: a systematic review and meta-analysis of randomized trials. Crit Care 23:262.

    Article  PubMed  PubMed Central  Google Scholar 

Download references


This study was supported in part by research grants from National Natural Science Foundation of China (NO.81600542).

Author information




GZ: project development and manuscript editing. ZZ and WW: data collecting and manuscript writing. TZ, XW: data collecting. YL: reviewed the manuscript.

Corresponding authors

Correspondence to Yongda Liu or Guohua Zeng.

Ethics declarations

Conflict of interest

The author(s) declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Zhao, Z., Wu, W., Zeng, T. et al. The impact of nephrostomy drainage prior to mini-percutaneous nephrolithotomy in patients with ESBL-positive Escherichia coli. World J Urol 39, 239–246 (2021).

Download citation


  • Extended-spectrum β-lactamase-producing Escherichia coli
  • Urosepsis
  • Percutaneous
  • Nephrolithotomy
  • Percutaneous nephrolithotomy