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Purpose <p>This study aimed to investigate the incidence of postoperative fever and identify predictors of Systemic Inflammatory Response Syndrome (SIRS) in patients undergoing Ureteroscopy (URS) and Flexible URS (F-URS) lithotripsy who presented with positive preoperative urine cultures despite prior antibiotic treatment.</p> Methods <p>A retrospective review was conducted on patients who underwent URS and F-URS lithotripsy between 2013 and 2024. The study identified 180 patients whose preoperative urine cultures remained non-sterile despite oral antibiotic therapy and who subsequently underwent surgery under appropriate intravenous antibiotic coverage following infectious disease consultation. Patients were stratified into two groups based on the development of fever in the postoperative one-week period: Group 1 (Fever, <i>n</i> = 55) and Group 2 (No Fever, <i>n</i> = 125). Univariate and multivariate analyses were performed to determine independent predictors of SIRS.</p> Results <p>Body Mass Index (BMI) was significantly higher in Group 1 compared to Group 2 (<i>p</i> &lt; 0.001). The most frequently isolated microorganisms were <i>Escherichia coli</i> (41.1%), <i>Klebsiella pneumoniae</i> (19.4%), and <i>Pseudomonas aeruginosa</i> (15%). Postoperative SIRS criteria were met in 34 cases (18.9%). In multivariate analysis, elevated BMI, isolation of <i>Klebsiella pneumoniae</i>, and prolonged operation time were identified as statistically significant independent predictors of SIRS development.</p> Conclusion <p>Prolonged operation time and elevated BMI are significantly associated with postoperative fever in patients undergoing URS and F-URS with positive urine cultures. Furthermore, the specific pathogen profile—particularly the presence of <i>Klebsiella pneumoniae</i>—serves as a critical predictor for SIRS, highlighting the need for vigilant perioperative management in this high-risk cohort.</p>

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Does the bacterial species matter? Predictors of systemic inflammatory response syndrome after ureteroscopy in patients with preoperative non-sterile urine

  • 期刊论文

  • 发表日期：

    2026年3月12日

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  • Ubeyd Sungur,
  • Hasan Sarıkoç,
  • Taner Kargı,
  • Yusuf Arıkan,
  • Mithat Ekşi,
  • Deniz Noyan Özlü,
  • Serdar Karadağ,
  • Alper Bitkin

摘要

Purpose

This study aimed to investigate the incidence of postoperative fever and identify predictors of Systemic Inflammatory Response Syndrome (SIRS) in patients undergoing Ureteroscopy (URS) and Flexible URS (F-URS) lithotripsy who presented with positive preoperative urine cultures despite prior antibiotic treatment.

Methods

A retrospective review was conducted on patients who underwent URS and F-URS lithotripsy between 2013 and 2024. The study identified 180 patients whose preoperative urine cultures remained non-sterile despite oral antibiotic therapy and who subsequently underwent surgery under appropriate intravenous antibiotic coverage following infectious disease consultation. Patients were stratified into two groups based on the development of fever in the postoperative one-week period: Group 1 (Fever, n = 55) and Group 2 (No Fever, n = 125). Univariate and multivariate analyses were performed to determine independent predictors of SIRS.

Results

Body Mass Index (BMI) was significantly higher in Group 1 compared to Group 2 (p < 0.001). The most frequently isolated microorganisms were Escherichia coli (41.1%), Klebsiella pneumoniae (19.4%), and Pseudomonas aeruginosa (15%). Postoperative SIRS criteria were met in 34 cases (18.9%). In multivariate analysis, elevated BMI, isolation of Klebsiella pneumoniae, and prolonged operation time were identified as statistically significant independent predictors of SIRS development.

Conclusion

Prolonged operation time and elevated BMI are significantly associated with postoperative fever in patients undergoing URS and F-URS with positive urine cultures. Furthermore, the specific pathogen profile—particularly the presence of Klebsiella pneumoniae—serves as a critical predictor for SIRS, highlighting the need for vigilant perioperative management in this high-risk cohort.