MP18-14 IS ONE WEEK ANTIBIOTIC PROPHYLAXIS NECESSARY BEFORE PERCUTANEOUS NEPHROLITHOTOMY? A RETROSPECTIVE REVIEW OF 7 VS 2 DAY THERAPY

Abstract

INTRODUCTION AND OBJECTIVES: Urosepsis is a complication of percutaneous nephrolithotomy (PCNL) that can occur despite sterile urine and studies have suggested that one week of prophylactic antibiotic therapy can reduce the risk of systemic inflammatory response syndrome (SIRS) and infectious complications in high risk patients with sterile urine. Approximately one-third of upper urinary tract stones harbor virulent microorganisms despite antibiotic therapy. Since antibiotic levels reach a steady state after only 48 hours, our goal was to determine whether antimicrobial therapy of 2 days is as effective as 7 days in preventing SIRS and infectious complications after PCNL. METHODS: We retrospectively reviewed 135 consecutive PCNLs performed by a single surgeon at one institution between January 2012 and October 2013. Preoperative urine cultures were obtained on all patients and positive cultures treated appropriately. Patients with sterile urine were divided into low or high risk (previous UTI, dilated pelvicaliceal systems or stones iÝ 20mm). Patients in the high risk group were treated with either 7 or 2 days antibiotics prior to PCNL. Antibiotic related adverse events and infectious outcomes were recorded for all patients and evaluated using univariate cumulative logit regression analysis. RESULTS: Of the 135 patients, 83 (61.5%) had sterile urine of which 59 (43.7%) met high risk criteria and were treated with either 7 days (31 pts) or 2 days (28 pts) preoperative antibiotics. Both groups were similar in age, gender, and duration of surgery. Comparing 7 vs 2 days treatment there was plevicalyectasis in 11 (35.5%) vs 8pts (28.6%), stone >20mm in 26 (83.8%) vs 23 (82.1%), and previous UTI in 15 (48.4%) vs 11pts (39.3%). There were 15 (25.4%) positive stone cultures overall, (10 pts in the 7 day group and 5 in the 2 day group). No patients in either group had a fever (temp >38.5), met SIRS criteria or developed a postoperative infection or sepsis after PCNL. There were no antibiotic associated complications. CONCLUSIONS: Prophylactic antibiotics for either 7 or 2 days prevented fever, SIRS and infectious complications in our high-risk patients with sterile urine before PCNL. This finding should be confirmed in a larger prospective trial. In the meantime, our results suggest that 2-days prophylactic antibiotics are equivalent to 7-days in reducing the risk of infectious complications after PCNL.