Analysis of factors associated with stent coloniization and urinary tract infections in patients with ureteral stent

Objective: Ureteral double J stents (DJs) are widely used in urology practice to ensure storage, support ureteral anastomoses and preserve renal function. However, their long-term indwelling triggers biofilm formation, which leads to antibiotic resistance and is readily available in situ. This provides the opportunity to contribute to the management of standard systems consisting of biofilms by analyzing the growing uropathogenic status of DJs, drug resistance profiles of these pathogens, stent dwell time and deterioration of carbon-coated stent health conditions. Material-Method: This retrospective study was conducted on patients who underwent DJs for various reasons between 2017 and 2021. A descriptive evaluation was made by analyzing the microorganisms isolated from DJs cultures, their infection status, and antibiotic/antifungal resistance profiles. In microbiological examinations, bacterial and fungal species were identified by inoculating them in appropriate media, antibiotic susceptibility tests were used to determine resistance profiles, and a statistical study was conducted on these findings.. Results: In this study, a total of 396 DJs cultures taken from 311 patients were evaluated, 53.4% of the patients were male and 46.6% were female. While a single microorganism was detected in 65.7% of the cultures, polymicrobial growth was observed in 34.3%. The most frequently isolated pathogens included Enterococcus spp. (29.5%), E. coli (17.9%), S. aureus (14.4%) and Candida spp. (15.2%). The infection rate of Gram-negative bacteria (32.9%) and the infection rate of Candida species (38.3%) were found to be statistically significantly high (p=0.004). In addition, multidrug resistance (MDR 39.6%, XDR 10.4%, PDR 0.9%) was detected more commonly, especially in Gram-negative bacteria, and it was determined that long-term DJs use was associated with antibiotic resistance. Conclusion: Long-term use of DJs stents has been directly associated with biofilm formation and increased antibiotic resistance, with Gram-negative bacteria and Candida species in particular standing out with high infection rates. Especially Gram-negative bacteria and Candida species have been associated with more polymicrobial growth and multidrug resistance, and it has been observed that MDR/XDR rates increase with long-term stent use. The use of carbon-coated stents in long-term stenting can be protective against urinary tract infection. In line with these findings, stent length of stay should be shortened as much as possible, measures should be taken to reduce biofilm formation, carbon-coated stents should be preferred whenever possible, and local antimicrobial susceptibility rates should be taken into account in empirical antibiotic selection. Keywords: DJ Stent, Carbon Coated, Infection, Colonization, Asymptomatic Bacteriuria