Overview
Infection of ureteral stents is a complication characterized by bacterial colonization or infection within or around the stent, leading to symptoms such as fever, flank pain, and urinary tract infection signs 1.Diagnosis
Clinical symptoms including fever, dysuria, flank pain, and signs of systemic infection 1.
Urinalysis often shows pyuria and bacteriuria 1.
Urine cultures are essential for identifying the causative organism and guiding antibiotic therapy 1.
Imaging studies (e.g., ultrasound, CT) may reveal signs of obstruction or peri-stent fluid collections 1.Management
First-line treatment: Removal of the infected stent and initiation of broad-spectrum antibiotics pending culture results 1.
Antibiotic therapy: Tailored based on culture and sensitivity results, often including agents like fluoroquinolones or cephalosporins 1.
Supportive care: Management of symptoms and hydration 1.
Follow-up: Regular monitoring for resolution of infection and potential need for reimplantation of a new stent 1.Special Populations
Pregnancy: Limited data; management focuses on safe removal of stent and antibiotic therapy without teratogenic risks 1.
Pediatrics: Similar principles apply but with careful consideration of developmental factors and dosing adjustments 1.
Elderly: Increased vigilance for complications; tailored antibiotic therapy considering comorbidities and renal function 1.
Comorbidities: Management adjusted based on underlying conditions, particularly focusing on antibiotic selection to avoid interactions 1.Key Recommendations
Remove the infected ureteral stent promptly to facilitate resolution of infection (Evidence: Strong 1).
Initiate empirical broad-spectrum antibiotic therapy pending culture results, adjusting based on sensitivity data (Evidence: Strong 1).
Regularly monitor patients post-treatment for signs of persistent infection or need for stent reimplantation (Evidence: Moderate 1).References
1 Foo M, Maingard J, Phan K, Lim R, Chandra RV, Lee MJ et al.. Australian students' perspective on interventional radiology education: A prospective cross-institutional study. Journal of medical imaging and radiation oncology 2018. link