MP65-09 IMPACT OF PERI-OPERATIVE ANTIBIOTIC CHOICE ON INFECTIOUS COMPLICATIONS AFTER PCNL - A PROSPECTIVE RANDOMIZED TRIAL

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy V (MP65)1 Sep 2021MP65-09 IMPACT OF PERI-OPERATIVE ANTIBIOTIC CHOICE ON INFECTIOUS COMPLICATIONS AFTER PCNL - A PROSPECTIVE RANDOMIZED TRIAL Henry Wright, Naveen Kachroo, Rajat Jain, Omar Mohammed, Donald Fedrigon, Anna Zampini, Smita De, Mark Noble, Manoj Monga, Wahib Isac, and Sri Sivalingam Henry WrightHenry Wright More articles by this author , Naveen KachrooNaveen Kachroo More articles by this author , Rajat JainRajat Jain More articles by this author , Omar MohammedOmar Mohammed More articles by this author , Donald FedrigonDonald Fedrigon More articles by this author , Anna ZampiniAnna Zampini More articles by this author , Smita DeSmita De More articles by this author , Mark NobleMark Noble More articles by this author , Manoj MongaManoj Monga More articles by this author , Wahib IsacWahib Isac More articles by this author , and Sri SivalingamSri Sivalingam More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002105.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The American Urological Association guidelines recommend peri-procedural antibiotics for percutaneous nephrolithotomy (PCNL), yet it is not clear which is superior. Given the risk of infectious complications after PCNL, we prospectively compared two common antibiotics: ciprofloxacin (cipro) versus cefazolin, on PCNL outcomes, focusing on the presence of systemic inflammatory response syndrome (SIRS) criteria. We hypothesized that the use of cipro will result in less infectious complications due to its broader spectrum for UTI coverage. METHODS: Adult patients undergoing PCNL were randomized to receive either cipro or cefazolin peri-operatively. All had negative pre-operative urine cultures. Demographic and peri-operative data were collected, including SIRS criteria, intra-operative urine culture, duration of hospitalization, and need for intensive care. SIRS is defined by ≥2 of the following: body temperature < 96.8 °F or >100.4 °F, heart rate > 90 bpm, respiratory rate >20 per minute, WBC count <4000 or > 12,000 cells/mm³. Wilcoxon-Mann-Whitney was used to compare continuous variables and a Chi-square test or Fisher’s exact test was used to compare categorical variables. All statistical analysis was performed using SPSS version 26 (IBM). RESULTS: One hundred twenty-two patients were enrolled and randomized (69 cefazolin, 53 cipro). Mean age was higher in the cipro group (61 vs. 57, p=0.02). All other pre-operative characteristics were similar (p>0.05). Intra and post-operative findings were similar, with no difference between groups (p>0.05), including the number of patients meeting SIRS criteria. There were 3 positive intra-operative urine cultures in the cefazolin group, versus none in the cipro group, although this was not significant (p=0.26). One patient required intensive care in the cipro group, versus none in the cefazolin group. There were no Clavien-Dindo ≥3 complications, and no adverse reactions to either antibiotic. CONCLUSIONS: Despite the relatively broader coverage for urinary tract pathogens with cipro, this prospective trial did not show superiority over cefazolin. Accordingly, we reject our hypothesis as this data shows cefazolin and cipro appear to have equal effects on post PCNL SIRS outcomes, allowing for more options with peri-operative antibiotic prophylaxis. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1122-e1122 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Henry Wright More articles by this author Naveen Kachroo More articles by this author Rajat Jain More articles by this author Omar Mohammed More articles by this author Donald Fedrigon More articles by this author Anna Zampini More articles by this author Smita De More articles by this author Mark Noble More articles by this author Manoj Monga More articles by this author Wahib Isac More articles by this author Sri Sivalingam More articles by this author Expand All Advertisement Loading ...