Conservative management feasible for uncomplicated renal colic patients with positive urine cultures

Conservative management of uncomplicated renal colic patients may be a feasible consideration following positive urine cultures (UCs), according to a retrospective analysis presented at the 2022 AUA Annual Meeting.1

“Though septic stones are well recognized as a medical emergency, patients with uncomplicated renal colic (without systemic inflammatory responses or renal impairment) and positive urine cultures pose a dilemma in management considerations,” the investigators explained in the abstract.

Therefore, they aimed to assess the rate of incidental positive urine cultures in patients with ureteral stones referred to their Stone Clinic, and to determine the risk of infectious adverse events (IAEs) in patients with ureteral stones and positive urine cultures.

In the retrospective chart review, investigators evaluated 1029 patient referrals between November 10, 2019, and October 1, 2020, excluding urgent referrals requiring immediate intervention.

In total, 374 (35.4%) patients had UCs drawn at presentation and 655 patients did not. Among those with no UCs, 0.6% (n = 6) went on to have sepsis and required urgent renal decompression. However, 87% (n = 333) of those with UCs were negative, and none of these patients went on to have an IAE.

Overall, 13% of UCs were positive (n = 39), but only 2 IAEs (5.13%) were identified from 2 to 30 days after patients’ initial presentation. Both patients had normal acute phase reactants and a history of recurrent urinary tract infections.

“Approximately one-third of patients referred to our Acute Stone clinic had UC at presentation, with an overall delayed IAE rate of 0.7%,” the investigators concluded. “Of those with positive urine cultures, only 5% experienced an IAE, suggesting conservative management may be a reasonable consideration in this patient population.”

Reference

1. Mookerji N, Mancuso M, Gandhi V, et al. Assessing the Risks of a Positive Urine Culture in Uncomplicated Renal Colic Patients. Journal of Urology. 207(55);5S:e1045. doi:JU.0000000000002670.10