Risk factors for positive urine culture and antimicrobial resistance in suspected UTI after flexible ureteroscopic lithotripsy.

BACKGROUND

This study identified independent risk factors for positive urine culture and bacterial resistance in patients with suspected urinary tract infection (UTI) after flexible ureteroscopic lithotripsy (FURL), to provide an evidence-based basis for individualized clinical antimicrobial treatment strategies.

METHODS

A retrospective cohort study enrolled 864 adult patients with suspected UTI after FURL who underwent urine culture between January 2024 and June 2025. Baseline clinical data were collected, and univariate and multivariate logistic regression analyses were used to identify independent risk factors for positive urine culture, pseudomonas aeruginosa infection, and bacterial resistance.

RESULTS

Univariate and multivariate logistic regression analysis demonstrated that advanced age, female gender, positive urine nitrite, positive urine glucose, urinary catheterization, hydronephrosis, and ureteral stricture were independent risk factors for positive urine culture in patients with suspected UTI after FURL. Young age and elevated urinary nitrite were identified as independent risk factors for Pseudomonas aeruginosa infection in patients with positive urine culture. Additionally, female gender was an independent risk factor for antimicrobial resistance in patients with positive urine culture, while diabetes mellitus was an independent protective factor for antimicrobial resistance with positive urine culture.

CONCLUSION

Distinct high-risk factors correlate with positive urine culture, P. aeruginosa infection and antimicrobial resistance in suspected UTI patients after FURL; stratified clinical assessment by these factors enables individualized antimicrobial therapy to improve treatment precision, reduce irrational antibiotic use and alleviate resistance development.