Investig Clin Urol.  2016 Nov;57(6):417-423. 10.4111/icu.2016.57.6.417.

Is extended preoperative antibiotic prophylaxis for high-risk patients necessary before percutaneous nephrolithotomy?

• Potretzke
• Park AM
• Bauman TM
• Larson JA
• Vetter JM
• Benway BM
• Desai AC

• KMID: 2451400
• DOI: http://doi.org/10.4111/icu.2016.57.6.417

Abstract

PURPOSE
The goal of this study was to compare the rate of systemic inflammatory response syndrome (SIRS) in high-risk patients undergoing percutaneous nephrolithotomy (PCNL) between patients who received 7, 2, or 0 days of preoperative antibiotics.
MATERIALS AND METHODS
We retrospectively reviewed a series of consecutive PCNLs performed at our institution. Patients with infected preoperative urine cultures were excluded. High-risk patients were defined as those with a history of previous urinary tract infection (UTI), hydronephrosis, or stone size ≥2 cm. Patients were treated with 7, 2, or 0 days of preoperative antibiotic prophylaxis prior to PCNL. All patients received a single preoperative dose of antibiotics within 60 minutes of the start of surgery. Fisher exact test was used to compare the rate of SIRS by preoperative antibiotic length.
RESULTS
Of the 292 patients identified, 138 (47.3%) had sterile urine and met high-risk criteria, of which 27 (19.6%), 39 (28.3%), and 72 (52.2%) received 7, 2, and 0 days of preoperative antibiotics, respectively. The 3 groups were similar in age, sex, and duration of surgery (p>0.05). There was no difference in the rate of SIRS between the groups, with 1 of 27 (3.7%), 2 of 39 (5.1%) and 3 of 72 patients (4.2%) meeting criteria in the 7, 2, and 0 days antibiotic groups (p=~1).
CONCLUSIONS
Extended preoperative antibiotic prophylaxis was not found to reduce the risk of SIRS after PCNL in our institutional experience of high-risk patients. For these patients, a single preoperative dose of antibiotics is sufficient.

Keyword

Antibiotic prophylaxis; Hydronephrosis; Percutaneous nephrostomy; Systemic inflammatory response syndrome; Urolithiasis

MeSH Terms

Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents/*administration & dosage
Antibiotic Prophylaxis/*methods
Drug Administration Schedule
Female
Humans
Male
Middle Aged
Nephrolithotomy, Percutaneous/*adverse effects/methods
Postoperative Care/methods
Retrospective Studies
Systemic Inflammatory Response Syndrome/etiology/*prevention & control
Unnecessary Procedures
Urinary Tract Infections/etiology/prevention & control
Urolithiasis/pathology/*surgery
Anti-Bacterial Agents

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