1176 A PROSPECTIVE STUDY EXAMINING THE INCIDENCE OF BACTERIURIA AND URINARY TRACT INFECTION POST-SHOCKWAVE LITHOTRIPSY: THE CASE AGAINST UNIVERSAL ANTIBIOTIC PROPHYLAXIS

Abstract

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Kidney & Bladder1 Apr 20111176 A PROSPECTIVE STUDY EXAMINING THE INCIDENCE OF BACTERIURIA AND URINARY TRACT INFECTION POST-SHOCKWAVE LITHOTRIPSY: THE CASE AGAINST UNIVERSAL ANTIBIOTIC PROPHYLAXIS Joshua D. Wiesenthal, Daniela Ghiculete, Michael Ordon, Kenneth T. Pace, and R. John D'A Honey Joshua D. WiesenthalJoshua D. Wiesenthal Toronto, Canada More articles by this author , Daniela GhiculeteDaniela Ghiculete Toronto, Canada More articles by this author , Michael OrdonMichael Ordon Toronto, Canada More articles by this author , Kenneth T. PaceKenneth T. Pace Toronto, Canada More articles by this author , and R. John D'A HoneyR. John D'A Honey Toronto, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.788AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Controversy exists over the need for antibiotic prophylaxis prior to shockwave lithotripsy (SWL). The AUA's Best Practice Policy Statement on Urologic Surgery Antimicrobial Prophylaxis uses level 1A evidence to indicate universal antibiotic prophylaxis, whereas the EAU's Guidelines on Urological Infections cites level 1A evidence to indicate prophylaxis only for patients with urinary drainage tubes, ureteral stents or infected stones. This prospective, single-centre quality assurance study evaluates the use of targeted antibiotic prophylaxis in patients undergoing SWL. METHODS Over a three-month period, patients undergoing SWL for renal and ureteral calculi were enrolled. All patients underwent urine dipstick, microscopy and culture prior to SWL. At our centre antibiotic prophylaxis was provided to patients with nephrostomy tubes, history of infected stones or urine dipsticks with both nitrites and leukocytes. The presence of ureteral stents was not an indication for prophylaxis. All patients had a urine culture performed 3 days post-SWL if they did not undergo antibiotic prophylaxis, or 2 days after finishing their course of antibiotic prophylaxis. All patients completed a survey documenting fevers or urinary symptoms up to one-week post-treatment. RESULTS 526 patients (63.7% male, 36.3% female) with a mean age of 54.17 years and BMI of 28.05 kg/m2 were enrolled. 78 (15.1%) patients underwent SWL with previously placed ureteral stents. Only 3 (13.0%) of the positive urine cultures taken prior to SWL were both leukocyte and nitrite positive on urine dipstick, whereas 17 (54.8%) of the positive urine cultures were both leukocyte and nitrite negative on dipstick. 10 (2.2%) patients were administered antibiotic prophylaxis (6 of which had ureteral stents), and 14 (2.7%) were given antibiotics post-treatment. Post-SWL, only 1 (0.2%) patient developed a urinary tract infection (UTI) and 4 (0.8%) patients developed asymptomatic bacteriuria CONCLUSIONS The rates of UTI and asymptomatic bacteriuria following SWL are extremely low (<1%) with targeted antibiotic prophylaxis. Furthermore, the ability of urine dipstick to screen for positive urine cultures is low in this urolithiasis population. This prospective case series questions the need for universal antibiotic prophylaxis prior to SWL, as well as the need for antibiotic prophylaxis in patients undergoing SWL with indwelling ureteral stents. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byMira Moreno A, Montoya Lirola M, García Tabar P, Galiano Baena J, Tenza Tenza J and Lobato Encinas J (2018) Incidence of Infectious Complications after Extracorporeal Shock Wave Lithotripsy in Patients Without Associated Risk FactorsJournal of Urology, VOL. 192, NO. 5, (1446-1449), Online publication date: 1-Nov-2014.Lu Y, Tianyong F, Ping H, Liangren L, Haichao Y and Qiang W (2018) Antibiotic Prophylaxis for Shock Wave Lithotripsy in Patients with Sterile Urine Before Treatment May be Unnecessary: A Systematic Review and Meta-AnalysisJournal of Urology, VOL. 188, NO. 2, (441-448), Online publication date: 1-Aug-2012. Volume 185Issue 4SApril 2011Page: e472 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joshua D. Wiesenthal Toronto, Canada More articles by this author Daniela Ghiculete Toronto, Canada More articles by this author Michael Ordon Toronto, Canada More articles by this author Kenneth T. Pace Toronto, Canada More articles by this author R. John D'A Honey Toronto, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...