All patients were found to have struvite stones.5 Similarly, in a group of patients undergoing ureteroscopic stone removal, Mariappan and Loong reported

that 25 of 75 patients had positive stone cultures, and 12 patients developed bacteremia with 7 exhibiting features of SIRS.6 Other selleck kinase inhibitor investigations have demonstrated that metabolic stones, in addition to infection stones, can harbor bacteria.7–12 This suggests that calculi Inhibitors,research,lifescience,medical of any composition can liberate bacteria during attempts at dilution calculator removal or fragmentation. In a large study involving 215 patients subjected to removal of renal or ureteral stones, Hugosson and colleagues noted that positive stone cultures were found in both infection and metabolic

stones.11 A total of 64 patients (30%) demonstrated bacterial growth in their stones: Inhibitors,research,lifescience,medical 71% of infection stones and 21% of metabolic stones were found to be infected. Some patients had more than one microorganism cultured from their stone, but the authors did not elaborate further on this topic. Bacteria that reside within urinary calculi may differ significantly from the bacteria that are present in voided urine, thereby potentially evading the initial antibiotic coverage. Margel and colleagues reported on Inhibitors,research,lifescience,medical 75 patients undergoing PCNL.1 A total of 17 had bacterial colonization in both their preoperative urine and surgical stone samples, and 6 demonstrated pathogens that differed in Inhibitors,research,lifescience,medical each specimen. Seventeen patients developed postoperative SIRS; in 13 of these patients, the antibiotic coverage was changed according to the stone culture results with subsequent clinical improvement in each case. On univariate analysis (multivariate analysis not

performed), the only factor that predicted the development of SIRS was a positive stone culture. Similarly, Inhibitors,research,lifescience,medical Ma and associates found that, on multivariate logistic regression analysis, positive stone culture was the strongest predictor of postoperative SIRS, which developed in 21 of 66 patients undergoing PCNL.13 A positive stone culture Carfilzomib was present in 49%. Fourteen of the 21 patients with SIRS were treated with antibiotics based on their stone culture, and all recovered uneventfully. In another study, Mariappan and colleagues found that a positive stone or renal pelvic urine culture in patients undergoing PCNL was associated with a fourfold relative risk of severe systemic infection.2 These investigator demonstrated similar findings in a cohort of patients subjected to ureteroscopic stone removal.6 Many investigators have reported on the specific bacterial species isolated from stone cultures after surgical stone removal (Table 2).1,2,6–12,14–16 These studies have shown that the most common organisms found in these cultures are E coli, Proteus species, Enterococcus, Klebsiella species, and Staphylococcus species.