Scoping Review on Management of Nephrostomy – and Double J-Stent – Associated Infections

Abstract

Catheter-associated urinary tract infections (CA-UTIs) refer to infections related to indwelling urinary catheters and are the main cause of hospital-acquired urinary tract infections. Most literature, including the European Urological Association (EAU) Urological Infections Guidelines, defines CA-UTIs as infections specifically associated with urethral catheters, excluding catheter-associated infections related to percutaneous nephrostomies and double-J stents. As a result, there are limited guidelines for managing these types of infections, namely, on determining when to change or remove the catheter. This is probably due to the scarcity of information, the lack of uniformization in terminology (bacteriuria versus infection) and the low evidence of available studies. This scoping review seeks to map the available evidence on infections associated with percutaneous nephrostomies (PN-UTIs) and double-J stents (DJ-UTIs). The review aims to address if studies provide a clear definition of asymptomatic bacteriuria and stent-associated infections; what are the most common pathogens associated with PN- and DJ-UTIs, and what recommendations are outlined in the literature for managing these infections. We performed this scoping review according to the PRISMA-ScR extension for scoping reviews. The search was made in the databases PubMed/MEDLINE, Scopus and Cochrane Library. We defined the following outcomes for analysis: type of stent, definition of bacteriuria and infection, urine and stent culture methods, pathogens, and information on treatment approach. The search yielded 441 articles, narrowed to 12 based on eligibility, relevance, and currency. Most studies, aside from two systematic reviews, were prospective and retrospective observational cohorts with small sample sizes (median 204 patients) and evidence level 3c. Stent-related infections were defined using inconsistent clinical criteria, with asymptomatic bacteriuria often undefined. Common pathogens included (26%), E. coli Enterococcus faecalis Pseudomonas aeruginosa (17%), and (14%). Urine cultures are typically performed using midstream urine samples, while stent cultures are primarily conducted for research purposes. Treatment approaches in the literature are highly variable. The management of catheters for source control is a topic with limited discussion, and recommendations vary, including stent replacement either before or after starting empirical antibiotics. A standardized treatment protocol remains to be established.