PURPOSE To identify early predictive factors for urosepsis secondary to mini-percutaneous nephrolithotomy (MPCNL) in patients with negative preoperative urine culture (UC). METHODS A total of 786 patients with baseline negative UC who underwent MPCNL between January 2017 and June 2019 were retrospectively analyzed. Urosepsis was defined according to the Sepsis-3 definition. Subsequently, perioperative potential risk factors were compared between non-urosepsis and urosepsis groups. RESULTS Despite negative UC in all patients, the rate of positive stone culture (SC) was 16.0%; the rate of pelvic urine culture (PUC) was 7.5%; 23 cases (2.9%) developed urosepsis after MPCNL. Univariate analysis showed that urosepsis was associated with the female gender, BMI, stone burden, diabetes mellitus and preoperative urine test. Multivariate logistic regression analysis suggested that urine test with positive nitrite and white blood cells and leukocyte esterase (N+WBC+LE+) (OR 17.51, 95% CI 6.75-45.38, P < 0.001) and operative time > 120 min (OR 3.53, 95% CI 1.41-8.85, P = 0.007) were independent risk factors for urosepsis. Additionally, receiver operating characteristic curve analysis of N+WBC+LE+ showed that the area under the curve was 0.785 for predicting the occurrence of urosepsis. Further analysis showed that N+WBC+LE+ provided an efficient prediction of SC+/PUC+ (SC+ or PUC+) with 61.7% sensitivity and 97.3% specificity. CONCLUSIONS In spite of the baseline negative preoperative UC, 2.9% of patients developed urosepsis after MPCNL. N+WBC+LE + was determined to be an early and efficient prediction of intraoperative bacterial status and urosepsis following MPCNL. Nevertheless, further studies are needed to confirm the results.

中文翻译：

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微型经皮肾镜取石术前术前尿培养阴性的尿毒症患者早期预测因素的评估。

目的确定术前尿培养阴性（UC）的继发于小型经皮肾镜取石术（MPCNL）的尿道炎的早期预测因素。方法回顾性分析2017年1月至2019年6月间接受MPCNL治疗的786例基线UC阴性的患者。尿菌属是根据脓毒症3定义定义的。随后，比较了非尿毒症患者和尿毒症患者围手术期的潜在危险因素。结果尽管所有患者的UC均为阴性，但结石培养阳性率为16.0％。盆腔尿培养（PUC）率为7.5％；MPCNL后有23例尿毒症（2.9％）出现。单因素分析表明，尿频与女性，体重指数，结石负担，糖尿病和术前尿液检查有关。多元logistic回归分析表明，亚硝酸盐和白细胞阳性和白细胞酯酶（N + WBC + LE +）阳性（OR 17.51，95％CI 6.75-45.38，P <0.001），手术时间> 120分钟（OR 3.53， 95％CI 1.41-8.85，P = 0.007）是尿检的独立危险因素。此外，对N + WBC + LE +的接收器工作特性曲线分析表明，曲线下的面积为0.785，可预测尿毒症的发生。进一步的分析表明，N + WBC + LE +提供了SC + / PUC +（SC +或PUC +）的有效预测，灵敏度为61.7％，特异性为97.3％。结论尽管术前UC基线为阴性，但仍有2.9％的患者在MPCNL后出现尿毒症。N + WBC + LE +被确定为MPCNL后术中细菌状态和尿检的早期有效预测。尽管如此，仍需进一步研究以确认结果。