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Enterococcus Predominates Following Endoscopic Urologic Procedures: A 30-Day Culture Analysis
Linda V. Nguyen, MD, Brooke L. Moore, MD, Dianne E. Sacco, MD, MS.
Massachusetts General Hospital, Boston, MA, USA.
BACKGROUND: Post-procedural urosepsis is a profound complication of endoscopic interventions. While E. coli has, historically, been the dominant pathogen, emerging data suggest increasing prevalence of Enterococcus, Proteus mirabilis, and Klebsiella spp. We sought to clarify the most common pathogens associated with urosepsis within 30 days of endoscopic urologic surgery to inform peri-operative antibiotic selection and empiric treatment.
METHODS: We performed a single-center retrospective observational cohort study of adults undergoing endoscopic interventions at an academic medical center from June 2020 to June 2023. Patients were included if they developed urosepsis within 30 days post-procedure. Procedures were categorized as diagnostic lower tract endoscopy, therapeutic lower tract endoscopy, diagnostic and therapeutic upper-tract endoscopy, catheter or suprapubic tract manipulation, and other endoscopic procedures. Stent-only placement or exchange procedures were excluded. Monomicrobial and polymicrobial isolates were included, with polymicrobial cultures counted per organism and analyzed at the genus level. Descriptive statistics summarized pathogen distribution.
RESULTS: During this three-year period, 11,206 endoscopic surgeries meeting inclusion criteria were identified. Of these, 211 culture-positive uroseptic events were identified for analysis. The most common organisms were Enterococcus spp. (25.1%), Escherichia coli (22.8%), Pseudomonas aeruginosa (22.3%), and Klebsiella spp. (17.1%). Enterococcus was the most frequent pathogen overall and demonstrated the highest prevalence in upper-tract endoscopy (26.5%), catheter/suprapubic manipulation (31.8%), and other endoscopic procedures (29.4%). Enterococcus prevalence was similar between upper- and lower-tract procedures (26.5% vs 23.9%, p=0.66).
CONCLUSIONS: Enterococcus spp. predominated overall and across multiple endoscopic procedure types, suggesting a shift from traditional gram-negative predominance and potential gaps in standard peri-operative prophylaxis. Broader empiric antimicrobial coverage may be warranted in select patients. Interpretation is limited by the retrospective single-center design and lack of surgeon standardization.
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