Incidence, risk factors and prognostic impact of pyelonephritis in cancer patients with percutaneous nephrostomy for malignant ureteral obstruction.

Abstract

Introduction and objectives: Percutaneous nephrostomy (PCN) is commonly used for malignant ureteral obstruction but carries significant infection risk in immunocompromised cancer patients. Data on pyelonephritis incidence, risk factors, and prognostic impact in this population remain limited. This study aimed to determine the incidence, risk factors, and prognostic impact of nephrostomy-related pyelonephritis and identify modifiable targets for infection prevention.

Materials and methods: In this prospective observational study, 115 adult patients with malignancy-associated grade ≥2 hydronephrosis who underwent primary PCN were followed for two years. Demographic, oncological and procedural data, handwashing education status and laboratory parameters were recorded. Serial urine, renal pelvis, skin and catheter tip cultures were obtained. Pyelonephritis was defined by fever, flank pain and inflammatory markers with a positive urine culture. Pyelonephritis-free survival and overall survival were analyzed using Kaplan-Meier and Cox regression models.

Results: During follow-up, pyelonephritis occurred in 65 patients (56.5%), with a mean pyelonephritis-free survival of 82.7 days. Female sex, prior colectomy, catheter dislocation, higher baseline WBC and higher C-reactive protein levels were independently associated with pyelonephritis. Two-year overall survival was 66.1% and baseline levels of albumin (low), WBC (high) and pyelonephritis presence independently predicted mortality. Handwashing education was strongly associated with a lower incidence of pyelonephritis and shorter hospital stay.

Conclusions: In patients with malignant ureteral obstruction requiring PCN, pyelonephritis is a common complication with prognostic implications. Hand hygiene education, better catheter care, early detection/treatment, and follow-up of routine laboratory markers may reduce infection burden and improve survival in this highly vulnerable population.