ONE WEEK OF CIPROFLOXACIN BEFORE PERCUTANEOUS NEPHROLITHOTOMY SIGNIFICANTLY REDUCES UPPER TRACT INFECTION AND UROSEPSIS: A PROSPECTIVE CONTROLLED STUDY

Abstract

Urosepsis after percutaneous nephrolithotomy (PCNL) is a severe complication, and its avoidance can sometimes be difficult despite antibiotic prophylaxis. Authors from the UK with a considerable experience in this procedure describe a prospective controlled study using ciprofloxacin for 1 week before PCNL, and found that it significantly reduces the risk of urosepsis. OBJECTIVE To evaluate whether 1 week of ciprofloxacin before percutaneous nephrolithotomy (PCNL) in patients with stones of ≥ 20 mm or pelvicalyceal dilatation, reduces urosepsis, as we previously reported that such patients have four times the risk of urosepsis after PCNL. PATIENTS AND METHODS Patients undergoing PCNL, and who fulfilled strict selection criteria, were recruited prospectively into a study which was conducted in two phases. The study methods were similar to those previously described; patients with dilated pelvicalyceal systems and/or stones of ≥ 20 mm from phase 1 (previously published) acted as controls. In the subsequent phase, the same selection criteria applied and only those with stones of ≥ 20 mm and/or dilated pelvicalyceal systems were given ciprofloxacin 250 mg twice daily for 1 week before PCNL and comprised the treatment arm. Midstream urine samples, renal pelvic urine and fragmented stones were collected to assess culture and sensitivity. Systemic inflammatory response syndrome (SIRS) was used to define urosepsis after PCNL. The urologists monitoring the patients after PCNL and conducting the analysis were all unaware of the characteristics of the stones or intravenous urography findings before PCNL. In all, 115 patients (54 in phase 1 and 61 in phase 2) were recruited, of whom 46 in phase 1 and 52 in phase 2 had stones of ≥ 20 mm and/or a dilated pelvicalyceal system, and became the control and treatment arms, respectively. RESULTS The patient demographics were similar in both arms. There was three times less risk of upper tract infection (relative risk 3.4, 95% confidence interval 1.0–11.8, P = 0.04) and SIRS (2.9, 1.3–6.3, P = 0.004) in the patients receiving ciprofloxacin (treatment arm). CONCLUSIONS The administration of oral ciprofloxacin for 1 week before PCNL in patients with stones of ≥ 20 mm or dilated pelvicalyceal systems significantly reduced the risk of urosepsis.