Persistent asymptomatic bacteriuria despite targeted antibiotic treatment predicts infectious complications after RIRS: a 10-year experience with 1122 procedures

PURPOSE: To evaluate the impact of persistently positive preoperative urine culture (pUC) despite tergeted antibiotic treatment on infectious complications (IC) after RIRS for stone treatment. METHODS: Prospectively collected data from Institution RIRS database (Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy) were analyzed - June 2014 to December 2024. Negative culture (nUC) received single-dose prophylaxis; pUC received targeted therapy and repeat culture. Persistent pUC underwent RIRS under antibiotic coverage. IC within 30 days were recorded. Descriptive statistics and multivariable logistic regression were performed. RESULTS: Among the 1,122 RIRS included, peristent pUC was found in 19.6% (220/1,122). Overall IC rate was 8.9% (100), including minor IC (Clavien I-II: 8.5%, n = 93), urosepsis (IVb: 0.5%, n = 6), and one death due to septic shock (V). IC were significantly more frequent in pUC patients (13.2% vs. 8.9%, p = 0.01). pUC group had significantly more females (62.6% vs. 34.1%), higher age (60.5 ± 15.7 vs. 55.8 ± 13.6 years), larger stones (12.7 ± 6.3 vs. 11.6 ± 5.2 mm) and higher comorbidity (CCI ≥ 2: 65.2% vs. 57.1%) - all p < 0.05. On multivariable analysis, pUC (OR 1.80, 95% CI 1.06-3.08, p = 0.03) and female sex (OR 1.67, 95% CI 1.02-2.75, p = 0.04) resulted independent predictors of IC. Limitations include the observational single-center design. CONCLUSIONS: Persistent asymptomatic bacteriuria increases the risk of postoperative IC after RIRS, despite guideline-based targeted therapy. Careful perioperative management, particularly in pUC and female patients, is essential to limit IC.