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PMUC versus RPUC or SC in predicting SIRS and urosepsis after PCNL: A systematic review and meta-analysis.

PURPOSE
To compare preoperative midstream urine cultures (PMUC) and renal pelvic urine culture (RPUC) or stone culture (SC) in predicting systemic inflammatory response syndrome (SIRS) and urosepsis after percutaneous nephrolithotomy (PCNL).


METHODS
We searched PubMed, Web of Science and EMBASE databases up to September 1, 2020 for relevant published studies. Two authors independently confirmed whether the literatures met the inclusion criteria and collected the data from the selected literatures. A meta-analysis was performed with Review Manager Software 5.4.1. A total of 14 studies with 3540 patients were selected and analyzed in the meta-analysis.


RESULTS
Pooled data showed that SC was associated with a higher sensitivity (OR 2.36, 95% CI 1.31-4.25; P < 0.00001), PPV (OR 1.54, 95% CI 1.18-2.01; P =0.16) and NPV (OR 1.17, 95% CI 1.01-1.37; P =0.06) in the diagnosis of SIRS and urosepsis after PCNL, and RPUC provided a significantly higher specificity (OR 2.70, 95% CI 2.16-3.38; P =0.07) and PPV (OR 2.17, 95% CI 1.49-3.15; P =0.48) than PMUC in the diagnosis of SIRS and urosepsis after PCNL.


CONCLUSION
Intraoperative SC and RPUC are more reliable than PMUC in predicting postoperative SIRS and urosepsis, identifying causative organisms and directing antibiotic therapy for patients underwent PCNL. PMUC, SC and RPUC should be routinely collected for the diagnosis and management of SIRS and urosepsis after PCNL.