MP30-03 IS PREOPERATIVE ANTIBIOTIC PROPHYLAXIS FOR HIGH-RISK PATIENTS NECESSARY BEFORE PERCUTANEOUS NEPHROLITHOTOMY? A RETROSPECTIVE REVIEW OF 7 VS 2 VS 0 DAY THERAPY

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy III1 Apr 2015MP30-03 IS PREOPERATIVE ANTIBIOTIC PROPHYLAXIS FOR HIGH-RISK PATIENTS NECESSARY BEFORE PERCUTANEOUS NEPHROLITHOTOMY? A RETROSPECTIVE REVIEW OF 7 VS 2 VS 0 DAY THERAPY Jeffrey Larson, Aaron Potretzke, Alana Desai, and Brian Benway Jeffrey LarsonJeffrey Larson More articles by this author , Aaron PotretzkeAaron Potretzke More articles by this author , Alana DesaiAlana Desai More articles by this author , and Brian BenwayBrian Benway More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.585AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Postoperative infection after percutaneous nephrolithotomy (PCNL) is a serious complication that can occur despite sterile urine. Previous studies have suggested that extended preoperative antibiotic therapy can reduce the risk of systemic inflammatory response syndrome (SIRS) in high-risk patients with sterile urine. The goal of this study is to investigate our expanded series comparing 7 vs 2 vs 0 days preoperative antibiotics in high-risk patients with sterile preoperative urine. METHODS We retrospectively reviewed 292 consecutive PCNLs performed by two surgeons at one institution between 2012 and 2014. Patients with positive preoperative urine cultures were excluded and those with sterile urine were divided into low- (excluded from this study) or high-risk (previous UTI, dilated pelvicaliceal system, or stone ≥20mm) groups. Patients in the high-risk group were treated with either 7, 2 or 0 days preoperative antibiotic prophylaxis prior to PCNL. This cohort was used in univariate and multivariate regression models to predict postoperative fever and SIRS. RESULTS Of the 292 patients, 192 (65.7%) had sterile urine of which 140 (47.9%) met high-risk criteria and were treated with either 7 days (27 pts), 2 days (40 pts) or 0 days (72 pts) prophylactic antibiotics. All three groups were similar in age, gender and duration of surgery. In patients treated with 7, 2 and 0 days preoperative antibiotic prophylaxis, 1 (3.7%), 2 (5%) and 3 (4.2%) patients met SIRS criteria. There was no significant difference between groups (Table 1). CONCLUSIONS Our previous study demonstrated that preoperative antibiotic prophylaxis of 7 vs 2 days was equivalent in preventing SIRS and infectious complications in high risk PCNL patients. The current study did not find a difference in postoperative infection between patients treated with extended prophylactic preoperative antibiotics and those given only perioperative antibiotic therapy on the day of surgery. Our results suggest that routine antibiotic prophylaxis in patients with sterile preoperative urine is not necessary to prevent postoperative infection. Table 1. Baseline characteristics Baseline patient characteristics 7-day 2-day 0-day p-value Number of patients 27 40 72 Mean age, years (SD) 55 (15.9) 57.8 (18.4) 56.5 (13.3) 0.562 Female gender (%) 17 (63) 23 (57.5) 33 (45.8) 0.05 Pelvicalyectasis, No. (%) 9 (33.3) 15 (37.5) 33 (45.8) 0.437 History of UTI, No. (%) 13 (48.1) 17 (42.5) 35 (48.6) 0.398 Stone ≥ 20mm, No. (%) 23 (85.2) 29 (72.5) 51 (70.8) 0.531 Mean stone size, (SD) 22.9 (8.5) 24.2 (12.3) 23.9 (12.1) 0.284 Surgery duration, min (SD) 141(54.9) 149(62.6) 104(38.5) 0.074 Infection Outcomes Postoperative fever, No. (%) 1 (3.7) 0 1 (1.4) 1 Met SIRS criteria, No. (%) 1 (3.7) 2 (5) 3 (4.2) 1 SIRS = Systemic Inflammatory Response Syndrome © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e347-e348 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeffrey Larson More articles by this author Aaron Potretzke More articles by this author Alana Desai More articles by this author Brian Benway More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...