Introduction & Objectives: Royal Darwin Hospital's urology unit identified an increased rate of sepsis following elective urological procedures through routine audit processes. This study aimed to evaluate current post-operative sepsis rates and assess the clinical utility of pre-operative urine cultures in predicting and preventing urosepsis. Key questions addressed included: optimal strategies to reduce post-operative sepsis rates, effectiveness of current antibiotic prophylaxis protocols, laboratory workup of mixed growth specimens, and management protocols for patients presenting without pre-operative urine cultures.
Methods: Retrospective audit conducted over 17 months (February 19, 2024 to July 13, 2025) analysing all cases of post-operative sepsis following elective urological procedures. Data collection included pre-operative urine cultures, post-operative urine cultures, blood cultures, and causative organisms. Sepsis incidence rates were calculated. Laboratory protocols for mixed growth reporting were reviewed, considering leukocyte counts and squamous epithelial cell contamination markers.
Results: 19 post-operative sepsis cases identified, representing a 2.2% incidence rate. Pre-operative urine results: 26% no growth, 32% mixed growth. Post-operative sepsis organisms: 47% (9 patients) had no causative organism identified, 42% (8 patients) developed bacteremia/candidemia. Notably, only 2 cases showed correlation between pre-operative urine culture and sepsis organism, including one infected obstructed stone case. One gentamicin-resistant E. coli bacteremia occurred despite pre-operative urine showing no growth. Only one sepsis patient lacked pre-operative urine collection, subsequently developing candidemia. No mortalities occurred during the study period.
Conclusions: Low sepsis rates (1.9–2.2%) following elective urological procedures demonstrate acceptable current standards. Poor correlation between pre-operative urine cultures and post-operative sepsis organisms questions the predictive value of routine pre-operative cultures. Mixed growth results primarily reflect contamination rather than clinically significant infection. Recommendations include: improved patient education for specimen collection, prospective audit of mixed growth specimens with intraoperative sampling, standardised protocols for patients without pre-operative cultures, and regular multidisciplinary meetings between urology and infectious diseases teams to optimise antimicrobial stewardship.