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Comparison of the roll-plate and sonication techniques in the diagnosis of microbial ureteral stent colonisation: results of the first prospective randomised study

Bonkat, G. ; Braissant, O. ; Rieken, M. ; Müller, G. ; Frei, R. ; van der Merwe, Andre ; Siegel, F. ; Gasser, T. ; Wyler, S. ; Bachmann, A. ; Widmer, A.

In: World Journal of Urology, 2013, vol. 31, no. 3, p. 579-584

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    Title
    • Comparison of the roll-plate and sonication techniques in the diagnosis of microbial ureteral stent colonisation: results of the first prospective randomised study
    Author
    • Bonkat, G.. Department of Urology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
    • Braissant, O.. Department of Urology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
    • Rieken, M.. Department of Urology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
    • Müller, G.. Department of Urology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
    • Frei, R.. Clinical Microbiology Laboratory, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
    • van der Merwe, Andre. Department of Urology, Faculty of Health Sciences, University of Stellenbosch, PO Box 19063, 7505, Tygerberg, South Africa
    • Siegel, F.. Department of Urology, University Hospital Mannheim, Ruprecht-Karls University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
    • Gasser, T.. Department of Urology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
    • Wyler, S.. Department of Urology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
    • Bachmann, A.. Department of Urology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
    • Widmer, A.. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
    Document Type
    • Postprint
    OAI-PMH Identifier
    • oai:doc.rero.ch:317416
    Summary
    Background: Microbial ureteral stent colonisation (MUSC) is one leading risk factor for complications associated with ureteral stent placement. As MUSC remains frequently undetected by standard urine cultures, its definitive diagnosis depends on microbiological investigation of the stent. However, a standard reference laboratory technique for studying MUSC is still lacking. Materials and methods: A total of 271 ureteral stents removed from 199 consecutive patients were investigated. Urine samples were obtained prior to device removal. Stents were divided into four parts. Each part was separately processed by the microbiology laboratory within 6h. Ureteral stents were randomly allocated to roll-plate or sonication, respectively, and analysed using standard microbiological techniques. Demographic and clinical data were prospectively collected using a standard case-report form. Results: Overall, roll-plate showed a higher detection rate of MUSC compared with sonication (35 vs. 28%, p<0.05) and urine culture (35 vs. 8%, p<0.05). No inferiority of Maki's technique was observed even when stents were stratified according to indwelling time below or above 30days. Compared with roll-plate, sonication commonly failed to detect Enterococcus spp., coagulase-negative staphylococci (CoNS) and Enterobacteriaceae. In addition, sonication required more hands-on time, more equipment and higher training than roll-plate in the laboratory. Conclusions: This prospective randomised study demonstrates the superiority of Maki's roll-plate technique over sonication in the diagnosis of MUSC and that urine culture is less sensitive than both methods. The higher detection rate, simplicity and cost-effectiveness render roll-plate the methodology of choice for routine clinical investigation as well as basic laboratory research