PD7-12 EXTENDED ANTIMICROBIAL USAGE IN PERCUTANEOUS NEPHROLITHOTOMY: INFECTIOUS AND ANTIBIOTIC RELATED COMPLICATIONS

Abstract

You have accessJournal of UrologyStone Disease: Therapy I1 Apr 2014PD7-12 EXTENDED ANTIMICROBIAL USAGE IN PERCUTANEOUS NEPHROLITHOTOMY: INFECTIOUS AND ANTIBIOTIC RELATED COMPLICATIONS Boyd Viers, Patrick Cockerill, and Amy Krambeck Boyd ViersBoyd Viers More articles by this author , Patrick CockerillPatrick Cockerill More articles by this author , and Amy KrambeckAmy Krambeck More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.701AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES One-third of upper urinary tract stones harbor microorganisms. As such, current guidelines recommend perioperative antimicrobial agents up to 24-hours at the time of percutaneous renal surgery. Our goal is to evaluate perioperative infectious and antibiotic associated complications in patients receiving extended antimicrobial therapy at percutaneous nephrolithotomy (PCNL). METHODS Between 2009 and 2012, 228 consecutive PCNL patients were retrospectively reviewed. Preoperative urine and stone cultures at time of PCNL were obtained. Patients with positive cultures received extended microbe directed therapy. All others received 7 days of empiric therapy pre and postoperatively. Antibiotic related adverse events and infectious outcomes were recorded. RESULTS There were 67 (31%) infected stones and 64 (31%) patients with positive preoperative urine culture. For sterile and infected stones, mean duration of pre and postoperative antibiotic therapy was 9 vs. 14 and 10 vs. 43 days. Nitrofurantoin, trimethoprim/sulfamethoxazole, or ciprofloxacin was administered pre in 114 (50%), 32 (14%), 42 (18%) and postoperatively in 90 (39%), 42 (18%), 34 (15%) patients. Forty-three (19%) patients had 48 infectious complications: 2 (0.9%) urosepsis, 27 (12%) SIRS, 3 (1%) pneumonia, 10 (4%) UTI (of which 5 (50%) had multi-drug resistant organisms) and 5 (2%) candidiasis. There were 20 (9%) antibiotic associated complications: 8 (4%) drug rash, 2 (0.9%) swelling, 6 (3%) gastrointestinal upset, 1 (0.4%) C. diff colitis, 1 transient renal insufficiency, 1 delirium and 1 shortness of breath. There was no significant difference in antibiotic or infectious related complications based on duration of antibiotic therapy pre (p=0.50 and 0.80) or postoperatively (p=0.76 and 0.23). Patients receiving multiple antibiotics postoperatively were more likely to experience an adverse drug event (11 (19%) vs. 8 (5%); p = 0.005). In those with a positive stone culture, 17 (46%) developed an infectious complication (p = 0.05). Diabetes, struvite stones and preoperative UTI were not significant predictors of infectious or antibiotic related complications. CONCLUSIONS With a prolonged course of antibiotic therapy at the time of PCNL, our data demonstrates a low rate of postoperative infection, specifically urosepsis, and antibiotic related complications in a high risk PCNL cohort. Postoperatively, multi-antibiotic therapy was associated with increased risk of adverse drug event. Furthermore, positive stone culture increased the risk of infectious complications. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e188 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Boyd Viers More articles by this author Patrick Cockerill More articles by this author Amy Krambeck More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...