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

Abstract 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.