Introduction: Ureteric stents can lead to irritative voiding symptoms which mimic UTIs. This population is thought to be at high risk of antibiotic over-exposure. Therefore, our objective was to assess local trends in antibiotic and multidrug-resistant organism (MDRO) patterns in patients with ureteric stents.
Methods: A population level retrospective cohort of patients undergoing ureteric stent insertion was created using provincially curated inpatient, ambulatory, and primary care data, through the Data Integration, Management and Reporting unit (DIMR) in Alberta (2013-18). Those with concurrent extirpative and reconstructive surgeries were excluded. Data 1 year pre- and post-stent insertion (SI) were collected, and descriptive analyses done on demographics, cultured organisms, prescriptions, and health care utilization. MDRO were defined as urine cultures (UC) with at least 3 resistances or known resistant species. Patients with post-SI MDRO were analyzed based on pre-SI urine culture results [no growth (NG), sensitive organisms (SO), and MDRO].
Results: Over the study period, 13,820 SI were completed. 78% (n=10,786) had a single stent placement. 58% were placed for stones and 18% for hydronephrosis. 7,436 UC were completed post-SI, and 35.4% were positive. Organisms with any resistance increased from 16% of all cultures pre-SI to 23.6% post-SI, with E. coli being most common. Ciprofloxacin resistance for E. coli significantly increased from 35% to 50% (p < 0.05) after SI.
MDRO increased from 1.2% (n=164) to 5.9% (n=815) after SI. 42% of these stents were placed for hydronephrosis and 21% for stones. 40% of these patients underwent repeat SI in the following year. 217 patients with NG and 434 with SO developed MDRO post-SI, within 2.9 and 2.7 prescriptions respectively. Patients with pre-SI MDRO were more likely to receive antibiotic prescriptions in the following year (NG 5.5 vs SO 5.7 vs MDRO 7.0) and received Ciprofloxacin 24% of time. Unplanned emergency visits were similar post-SI for the three groups (4.0 vs 4.0 vs 4.7, p=0.23), but pre-SI MDRO had significantly more emergency visits in the year prior to SI (2.6 vs 3.1 vs 4.3, p<0.0001).
Conclusions: An increase in MDRO was observed after SI which was associated with an increased number of antibiotic prescriptions and increasing ciprofloxacin resistance. Unplanned emergency visits were significantly higher in patients with pre-SI MDRO, but similar post-SI.
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