Recommendations of the AFU Infectious Diseases Committee on the prevention, diagnosis and treatment of infections of endo-ureteral equipment

Elsa Bey (1) , Kévin Bouiller (2, 3) , Romain Pimpie (4) , Constance Le Goux (5) , J. Tourret-Arnaud , Gérard Lina (6) , Samy Figueiredo (7) , Anthony Chauvin (8) , Gaëtan Gavazzi (9) , Sandra Malavaud (10) , Albert Sotto (11, 12) , Maxime Vallée (13) , Franck Bruyère (14)

1 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
2 LCE - Laboratoire Chrono-environnement (UMR 6249)
3 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
4 Ramsay Santé
5 Service d'urologie [CH René Dubos Pontoise]
6 UCBL - Université Claude Bernard Lyon 1
7 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
8 Hôpital Lariboisière-Fernand-Widal [APHP]
9 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
10 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
11 CHU Nîmes - Hôpital Universitaire Carémeau [Nîmes]
12 VBMI - Virulence bactérienne et maladies infectieuses
13 CHU de Poitiers - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
14 Service d'urologie [Tours]

Introduction: No recent national guidelines exist regarding the management of urinary tract infections (UTIs) in the presence of ureteral stent. This situation could lead to discrepancies in clinical management and less opportunity for a favorable patient's outcome.Methods: All available data published on Medline® between 1998 and 2018 were systematically searched and reviewed. All papers assessing adult patients carrying ureteral stent were included for analysis. After studies critical analysis, national guidelines for clinical management were elaborated in order to answer clinical questions.Results: A total of 451 articles were identified, of which 58 have been included. The prevalence of urinary tract infections in the presence of ureteral stent remains unknown. After 3 months, all endo-ureteral devices were colonized on microbiological study. These patients also presented a positive urine culture in 25 to 70% of the cases, often polymicrobial. Staphylococci, E. coli, Klebsiella, Pseudomonas, Enterococcus and Candida were the commonest micro-organisms responsible for urinary colonization or infection. The risk of UTI on endo-ureteral devices seemed higher the longer it stayed implanted. There is no justification in the literature to recommend a systematic change of endo-ureteral devices following a urinary tract infection.Discussion: The existing literature is rich but of poor methodological quality, and therefore does not allow to draw robust conclusions. The greatest difficulty faced in this work was to accurately differentiate urinary colonizations from true infections, including clinical symptoms and not only microbiological results.Conclusion: These guidelines propose a standardized management of such common clinical situations. Well-designed studies are needed to upgrade the level of evidence of these guidelines.

Mots clés: Double J; Double j; Infection urinaire; Pigtail; Pyelonephritis; Pyélonéphrite; Sonde urétérale; Ureteral stent; Ureteric stent; Urinary tract infection

Domaines: Médecine humaine et pathologie; Microbiologie et Parasitologie; Urologie et Néphrologie

Elsa Bey, Kévin Bouiller, Romain Pimpie, Constance Le Goux, J. Tourret-Arnaud, et al.. Recommendations of the AFU Infectious Diseases Committee on the prevention, diagnosis and treatment of infections of endo-ureteral equipment. Progrès en Urologie, 2021, 31 (10), pp.557-575. ⟨10.1016/j.purol.2021.02.005⟩. ⟨hal-03364411⟩