Investigating raised white cells,sepsis and antibiotic administration in obstructive urolithiasis: A retrospective cohort analysis

Abstract

Objectives:

Patients with obstructive ureteric calculi frequently present with leucocytosis, prompting empirical antibiotic treatment. Evidence for antibiotics in these cases is limited. This study investigated whether leucocytosis is a reliable marker of sepsis in obstructive urolithiasis, and assessed factors associated with sepsis after emergency department (A&E) discharge, including antibiotic administration.

Methods:

Retrospective data collection was performed on all patients with computed tomography (CT)-proven ureteric calculi presenting to a single centre A&E between October 2019 and October 2020. Data were collected on patient demographics, comorbidities, stone factors, serum and urinalysis and relevant culture results. Multivariable regression analysis assessed significant correlations for immediate/delayed sepsis, serum leucocytes and antibiotic administration.

Results:

In total, 392 patients (298:98 M:F) met the inclusion criteria. Raised leucocytes were found in 212 patients (54.4%) with 24 patients (6.1%) admitted immediately with sepsis, and 12 (3.1%) returning with sepsis. In total, 83 patients received antibiotics, of whom 57 (68.7%) had no immediate or delayed sepsis. Multivariable regression showed immediate sepsis significantly associated with stone size, presence and degree of type 2 diabetes (p < 0.012). Re-presentation with sepsis significantly correlated with female gender and multiple stones (p < 0.039) with antibiotic administration showing no benefit. Raised leucocytes showed no relation to immediate sepsis or delayed sepsis (p > 0.33).

Conclusions:

Leucocytosis alone is not a reliable marker of sepsis with obstructing ureteric stones. Septic patients are more likely to have severe diabetes with larger stones; female patients with multiple calculi are more likely to re-present with sepsis. In our cohort, antibiotics did not prevent re-presentation with sepsis and should not be given unnecessarily.

Level of evidence:

Level 4