Urologic perioperative infection outcomes and prescribed antibiotics

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OBJECTIVE: Postoperative infection after surgical nephrolithiasis procedures is a significant morbidity concern. Preoperative antibiotics are recommended by multiple professional guidelines to prevent life-threatening infection. However, the efficacy of different antibiotic approaches continues to be poorly understood. The primary objective of this study was to investigate the relationship between perioperative antibiotic regimens and incidence of postoperative urinary tract infection (UTI), systemic inflammatory response syndrome (SIRS), and urosepsis. METHODS: A retrospective analysis of prospectively collected data from the Registry for Stones of the Kidney and Ureter (ReSKU) was conducted in this case-cohort study of patients who underwent nephrolithiasis surgery. Subjects whose stone surgery occurred between 2015 and 2021, had a definitive preoperative urine culture, received perioperative antibiotics, and completed a postoperative follow-up visit were included. 25 subjects experienced postoperative UTI, SIRS, or sepsis. 240 did not have any infection-related postoperative issues. Chi-Square tests were performed to determine if there was a relationship between categorical variables of interest [sex, urine culture results, antibiotic regimen, and route of antibiotic administration (oral or intravenous)] and a postoperative infectious outcome. RESULTS: Postoperative infection was found to be significantly associated with sex [χ2 (1, N=265) = 4.73, p=0.030] but not with urine culture results [χ2 (1, N=265) = 1.86, p=0.17], antibiotic regimen [χ2 (29, N=265) = 44.59, p=0.77], or route of antibiotic administration [χ2 (3, N=265) = 2.22, p=0.53]. A likelihood ratio of 6.9 was seen between positive urine culture and postoperative infection. CONCLUSION: The risk for postoperative infection after stone surgery is higher among women compared to men. Our data demonstrate no basis for specificity of antibiotic regimen to prevent postoperative infections after surgical nephrolithiasis treatment. To reduce risk of postoperative infection, more important than type of antibiotic, route of administration, or urine culture is simply the importance of consistently giving preoperative antibiotics. These data support AUA and EUA guidelines on the importance of preoperative antibiotics to reduce infectious morbidity after surgery.