Antibiotic Prophylaxis In Patients Research Articles

Gastrointestinal functions after laparoscopic right colectomy with intracorporeal anastomosis: a pilot randomized clinical trial on effects of abdominal drain, prolonged antibiotic prophylaxis, and D3 lymphadenectomy with complete mesocolic excision

PurposeRoutine use of abdominal drain or prolonged antibiotic prophylaxis is no longer part of current clinical practice in colorectal surgery. Nevertheless, in patients undergoing laparoscopic right hemicolectomy with intracorporeal anastomosis (ICA), it may reduce perioperative abdominal contamination. Furthermore, in cancer patients, prolonged surgery with extensive dissection such as central vascular ligation and complete mesocolon excision with D3 lymphadenectomy (altogether radical right colectomy RRC) is called responsible for affecting postoperative ileus. The aim was to evaluate postoperative resumption of gastrointestinal functions in patients undergoing right hemicolectomy for cancer with ICA and standard D2 dissection or RRC, with or without abdominal drain and prolonged antibiotic prophylaxis.MethodsMonocentric factorial parallel arm randomized pilot trial including all consecutive patients undergoing laparoscopic right hemicolectomy and ICA for cancer, in 20 months. Patients were randomized on a 1:1:1 ratio to receive abdominal drain, prolonged antibiotic prophylaxis or neither (I level), and 1:1 to receive RRC or D2 colectomy (II level). Patients were not blinded. The primary aim was the resumption of gastrointestinal functions (time to first gas and stool, time to tolerated fluids and food). Secondary aims were length of stay and complications’ rate. ClinicalTrials.gov no. NCT04977882.ResultsFifty-seven patients were screened; according to sample size, 36 were randomized, 12 for each arm for postoperative management, and 18 for each arm according to surgical techniques. A difference in time to solid diet favored the group without drain or antibiotic independently from standard or RRC. Furthermore, when patients were divided with respect to surgical technique and into matched cohorts, no differences were seen for primary and secondary outcomes.ConclusionAbdominal drainage and prolonged antibiotic prophylaxis in patients undergoing right hemicolectomy for cancer with ICA seem to negatively affect the resumption of a solid diet after laparoscopic right hemicolectomy with ICA for cancer. RRC does not seem to influence gastrointestinal function recovery.

Temporal Trends, Healthcare Resource Utilization and In-hospital Outcomes of Very Early Infective Endocarditis After Transcatheter Edge-to-Edge Repair

Current practice guidelines recommend antibiotic prophylaxis in patients with high-risk congenital heart conditions, including those with Prosthetic heart valves and prosthetic material, including annuloplasty rings or clips undergoing invasive dental procedures. However, there is limited clinical data on the burden of infective endocarditis (IE) following Mitral TEER. This study investigated temporal trends of very early IE immediately after TEER using National Inpatient Sample from 2016 - 2020. It showed that the rate of very early TEER-related IE was relatively low over the five years of analysis and that there was a downward trend of very early IE after TEER.

Continuous antibiotic prophylaxis in patients with vesicoureteral reflux: Less is more.

Continuous antibiotic prophylaxis in patients with vesicoureteral reflux: Less is more.

Ureterorenoscopic Stone Removal without Antibiotic Prophylaxis

Introduction: The aim of this study was to assess the feasibility of sparing routine antibiotic prophylaxis in patients without preoperative urinary tract infection undergoing ureterorenoscopy (URS) for stone removal. Methods: A retrospective, monocentric study was conducted to evaluate the outcome of a modified perioperative antibiotic management strategy according to the principles of antibiotic stewardship. Patients with preoperative unremarkable urine culture received no antibiotic prophylaxis for URS stone removal (NoPAP). The NoPAP group was compared to a historic URS cohort, when antibiotic prophylaxis (PAP) was standard of care. Analysis focused on postoperative complications. Results: Postoperative fever occurred in 1% of the NoPAP and 2% of the PAP patients (p = 0.589). Clavien 1–3 complications did not differ between groups with 9% in the NoPAP and 6.2% in the PAP (p = 0.159). No Clavien 4–5 complications were seen. We identified a residual stone (p = 0.033) and an ASA score 3–4 (p = 0.004) as significant risk factors for postoperative fever. By sparing routine antibiotic prophylaxis, the overall antibiotic usage was reduced from 100% (PAP) to 8.3% (NoPAP). Conclusion: Sparing a routine antibiotic prophylaxis during URS for stone removal seems feasible in patients with unremarkable preoperative urine culture for most of the patients. A prospective validation is warranted.

Cefazolin as the mainstay for antibiotic prophylaxis in patients with a penicillin allergy in obstetrics and gynecology

Cefazolin is the most common antibiotic used for prophylaxis in obstetrics and gynecology. Among those with a penicillin allergy, alternative antibiotics are often chosen for prophylaxis given fears of cross-reactivity between penicillin and cefazolin. Alternative antibiotics in this setting are associated with adverse sequalae including surgical site infection, induction of bacterial resistance, higher costs to the healthcare system, and possible Clostridium difficile infection. Given the difference in R1 side chains between the penicillin and cefazolin, cefazolin use is safe and should be recommended for penicillin allergic patients including those who experience IgE-mediated reactions such as anaphylaxis. Cefazolin should only be avoided in those who experience a history of a severe, life-threatening delayed hypersensivity reaction manifested as severe cutaneous adverse reactions (Steven-Johnson Syndrome), hepatitis, nephritis, serum sickness, and hemolytic anemia in response to penicillin administration. Additionally, over 90% of those with a documented penicillin allergy do not have true allergy on skin testing. Increased referral for penicillin allergy testing should be incorporated into routine obstetric care and preoperative assessment to reduce suboptimal antibiotic prophylaxis use. More education is needed among providers surrounding penicillin allergy assessment and cross-reactivity among penicillins and cephalosporins to optimize antibiotic prophylaxis in obstetrics and gynecology.

Antibiotic prophylaxis for patients with acute brain injury

Antibiotic prophylaxis for patients with acute brain injury

Late Manifestation of Congenital Heart Disease: Right-side Infective Endocarditis and the Mystery of the Unseen Ventricular Septal Defect: Case Report

Infective endocarditis (IE) is a severe complication in patients with congenital heart disease. However, CHD-associated mortality has decreased to 10% because of improvements in the diagnosis of infective endocarditis, antibiotic therapy, cardiac surgery, and interventional procedures. Herein, we aimed to illustrate a case of right-sided infective endocarditis associated with an unknown ventricular septal defect, complicated by septic pulmonary emboli as a rare form of delayed presentation of congenital heart disease.
 The significant occurrence of infective endocarditis prompts the need for additional investigations into the current utilization, necessity, and effectiveness of antibiotic prophylaxis in patients with congenital heart disease (CHD).

Infective Endocarditis Antibiotic Prophylaxis: Review of the Evidence and Guidelines.

The question of antibiotic prophylaxis and its role in prevention of infective endocarditis (IE) remains controversial, with differing recommendations from international societies. The aim of this review was to compare and contrast current recommendations on antibiotic prophylaxis for IE by the American Heart Association (AHA), the European Society of Cardiology (ESC), and the National Institute for Health and Care Excellence (NICE) and highlight the evidence supporting these recommendations. International guidelines for administration of antibiotic prophylaxis for prevention of IE are largely unchanged since 2009. Studies on the impact of the more restrictive antibiotic prophylaxis recommendations are conflicting, with several studies suggesting lack of adherence to current guidance from the ESC (2015), NICE (2016), and AHA (2021). The question of antibiotic prophylaxis in patients with IE remains controversial, with differing recommendations from international societies. Despite the change in guidelines more than 15years ago, lack of adherence to current guidelines persists. Due to the lack of high-quality evidence and the conflicting results from observational studies along with the lack of randomized clinical trials, the question of whether to recommend antibiotic prophylaxis or not in certain patient populations remains unanswered and remains largely based on expert consensus opinion.

Efficacy of Primary Prophylaxis in Patients with MDS or AML Treated with Non-Intensive Agents: Systematic Review with Meta-Analysis

Background: Infections are common among patients with myelodysplastic syndromes/neoplasms (MDS) and acute myeloid leukemia (AML) due to neutropenia, which leads to increase in hospitalization, morbidity and mortality. Antibiotic prophylaxis has been proven to reduce the incidence of infections in oncologic and hematooncologic patients receiving intensive chemotherapies. Accordingly, most hematology and oncology societies advice for its use especially in high-risk patients. These recommendations, however, cannot be directly extrapolated to elderly MDS or AML patients treated with less intensive regimens such as single agent hypomethylating agents (HMA) or low-dose cytarabine (LDC), as controlled prospective randomized trials are not available in this context. Aim: The aim of this systematic review was to summarize published data on the efficacy and safety of primary antibiotic prophylaxis in patients with MDS or AML treated with non-intensive agents and perform a meta-analysis. Methods: We performed a systematic review using PubMed and Embase databases on 14th September 2022 without time-restrictions concerning publication data. Inclusion criteria comprised demographics (adult), type of study (retrospective and prospective cohort studies, case control studies, randomized controlled trials), study population (patients with MDS, MDS/MPN or AML), and treatment (hypomethylating agent (HMA), low-dose cytarabine (LDC)). Study outcomes/endpoints included information on efficacy (reduction of infection or fever episodes requiring antibiotic treatment (bacterial, viral, fungal), hospitalizations, intensive care unit admissions or leading to dearth) and safety (antibiotic side-effects and resistance) of primary antibiotic prophylaxis. Meta-analysis was performed and odds ratios with 95% confidence intervals shown in a Forrest Plot. Results: From 233 screened studies, we identified no randomized or prospective studies and only two retrospective studies with 68 patients and 346 treatment cycles that matched our inclusion/exclusion criteria. ( A). One study included AML (n=40, Bainschab et al, 2016) and the other MDS patients (n=28 , Lee et al, 2011). Patients recived primary antibiotic prophylaxes in 79/215 (25%) and 95/131 (72.5%) treatment cycles, respectively (B). The antibiotics used included fluorquinolones (92.5% and 95%), penicillins (6.5% and 0%) and cephalosporins (1% and 5%). Infections episodes were reported in 53/215 (25%) and 15/131 (11%) treatment cycles. A meta-analysis of the selected studies suggests a significant benefit in reducing the incidence of infection or febrile episodes (OR 0.43 [0.25-0.75], p<0.003) with potential reduction in hospital admission, especially in patients with low ANC (< 0.5 G/l). As additional risk factors for infectious complications we identified severe cytopenia (grade ≥3) in at least one lineage, earlier therapy cycles, transfusion dependency, increased LDH and high Charlson Comorbidty Index. Data regarding the safety and tolerability of antibiotic prophylaxis was not available. Conclusion: Our investigation with only few eligible studies, patients and treatment cycles underlines an unmet need for prospective controlled trials in this field.Our systematic review with meta-analysis suggests a significant benefit of antibiotic prophylaxis in MDS and a tendency in AML patients undergoing single agent HMA or LDC treatment. Those individuals with high-risk features seem to have the greatest benefit. Prospective, controlled and randomized trials are, however, lacking and should be encouraged, even more as combinations with venetoclax are becoming the standard of care in AML and potentially also in MDS with higher risk of neutropenic infekctions.

THE ROLE OF PROPHYLACTIC ANTIBIOTICS IN ZONE II AND ZONE V ACUTE FLEXOR TENDON INJURIES

Our study sought to establish the necessity of prolonged pre-operative antibiotic prophylaxis in patients presenting with zone II and zone V acute flexor tendon injuries (FTI). We hypothesized that a single dose of prophylactic antibiotic was adequate in prevention of post-operative wound infection in acute zone II and V FTI.This was a prospective study of 116 patients who presented with zone II and zone V acute FTI. The study included patients who were 18 years and older. Those with macroscopic contamination, immunocompromised, open fractures, bite injuries, and crush injuries were excluded. Patients were randomised into a group receiving a single dose of prophylactic antibiotic and another group receiving a continuous 8 hourly antibiotic doses until the day of surgery. Each group was subdivided into occupational and non-occupational injuries. Their post-operative wound outcomes were documented 10 – 14 days after surgery. The wound outcome was reported as no infection, superficial infection (treated with wound dressings), and deep infection (requiring surgical debridement).There was 0.9% rate of deep post-operative wound infections, which was a single zone V acute FTI case in a single dose prophylactic antibiotic group. There was a 7.8% superficial post-operative wound infection rate, which was mainly zone II acute FTI in both antibiotic groups. There was a strong association between zone II acute FTI and post-operative wound infection (p < 0.05). There was no association between (antibiotic dosage or place of injury) with post-operative wound infection (p > 0.05).There is no benefit in prescribing prolonged pre-operative antibiotic in patients with acute, simple lacerations to zone II and zone V FTI if there is no macroscopic wound contamination.

Multifactorial Analysis of Biliary Infection in Patients with Hepato-pancreatico-biliary and Associated Intraabdominal Malignancies Admitted to a Teaching Hospital in Northern India.

Blockage of the biliary tract is commonly caused by malignant tumors leading to deranged liver function, responsible for poor prognosis and a high rate of bacteriobilia leading to mortality. We collected retrospective data from the hospital information system and laboratory registers in our department from 2021 to 2022 to evaluate biliary infections in patients with hepato-pancreatico-biliary and associated intraabdominal malignancies. A total of 118 (118/234, 50.43%) patients' bile samples were estimated in this study. Patients' average age was 53.02 ± 13.49 years, with more patients below the age of 65 years among those with infected bile samples. Eight patients were infected by 102 pathogenic microorganisms. The most common pathogenic microorganism responsible for biliary infection in patients with abdominal malignancies was Escherichia coli (38/102, 37.25%) followed by Klebsiella pneumoniae (21/102, 20.59%) and Enterococcus spp. (18/102, 17.65%). Underlying comorbidities like diabetes mellitus, hypothyroidism, hypoproteinemia, chronic liver disease, immunosuppression, chronic kidney disease, increased hospital stay, admission to the intensive care unit (ICU), and presence of percutaneous transhepatic biliary drain were statistically significant risk factors for isolation of multidrug-resistant pathogenic bacteria. Our study guided physicians in identifying the associated demographic characteristics, risk factors, and the spectrum of pathogens responsible for bacteriobilia in abdominal cancer patients along with the antibiotic resistance pattern among these isolates and better selection of antibiotics and antibiotic prophylaxis for patients at risk of developing biliary tract infections with multidrug-resistant pathogens. Kar M, Dubey A, Patel SS, et al. Multifactorial Analysis of Biliary Infection in Patients with Hepato-pancreatico-biliary and Associated Intraabdominal Malignancies Admitted to a Teaching Hospital in Northern India. Euroasian J Hepato-Gastroenterol 2023;13(1):10-17.

Prophylactic antibiotic use for infective endocarditis: a systematic review and meta-analysis

ObjectivesInfective endocarditis (IE) is a devastating disease with a 50% 1-year mortality rate. In recent years, medical authorities across the globe advised stricter criteria for antibiotic prophylaxis in patients with...

The 2023 MANCTRA Acute Biliary Pancreatitis Care Bundle: A Joint Effort Between Human Knowledge and Artificial Intelligence (ChatGPT) to Optimize the Care of Patients With Acute Biliary Pancreatitis in Western Countries.

To generate an up-to-date bundle to manage acute biliary pancreatitis using an evidence-based, artificial intelligence (AI)-assisted GRADE method. A care bundle is a set of core elements of care that are distilled from the most solid evidence-based practice guidelines and recommendations. The research questions were addressed in this bundle following the PICO criteria. The working group summarized the effects of interventions with the strength of recommendation and quality of evidence applying the GRADE methodology. ChatGPT AI system was used to independently assess the quality of evidence of each element in the bundle, together with the strength of the recommendations. The 7 elements of the bundle discourage antibiotic prophylaxis in patients with acute biliary pancreatitis, support the use of a full-solid diet in patients with mild to moderately severe acute biliary pancreatitis, and recommend early enteral nutrition in patients unable to feed by mouth. The bundle states that endoscopic retrograde cholangiopancreatography should be performed within the first 48 to 72 hours of hospital admission in patients with cholangitis. Early laparoscopic cholecystectomy should be performed in patients with mild acute biliary pancreatitis. When operative intervention is needed for necrotizing pancreatitis, this should start with the endoscopic step-up approach. We have developed a new care bundle with 7 key elements for managing patients with acute biliary pancreatitis. This new bundle, whose scientific strength has been increased thanks to the alliance between human knowledge and AI from the new ChatGPT software, should be introduced to emergency departments, wards, and intensive care units.

The use of antibiotic prophylaxis in patients undergoing urologic procedures in an academic hospital Surabaya: A retrospective study.

Prophylactic antibiotics in urological procedures are essential to prevent postoperative infections. A different approach in selecting antibiotic prophylaxis according to the type of procedure is needed. A retrospective study was carried out at an academic hospital in Surabaya, Indonesia, by collecting medical records of patients who underwent urologic procedures within 2019- 2020, including microbiological data. One hundred seventy-nine urological procedures were assessed. Antibiotic prophylaxis was administered in the clean-contaminated and clean procedures (93.2% and 6.8%, respectively). Ceftriaxone was commonly used (69.3%), single-dose, one day before the surgery. Gram-negative bacteria were widely found in the urinary culture of patients (75.2%). E. coli, K. pneumoniae, and P. aeruginosa were dominating with low susceptibility to cephalosporins. ESBL-producing bacteria were E. coli (64%) and K. pneumoniae (89%). The 3rd generation cephalosporins (ceftriaxone) are mostly used in urological procedures despite the low susceptibility against this antibiotic in cultured E coli, P. aeruginosa, and K. pneumonia. The aminoglycosides have relatively good activity and have been suggested in several guidelines for urologic procedures, such as prostate and urinary tract stone procedures. It is crucial to consider the incision site, type of procedure, and bacterial profile in the hospital to propose antibiotic prophylaxis guidelines.

The five-year trends in antibiotic prescription by dentists and antibiotic prophylaxis for tooth extraction: a region-wide claims study in Japan

BackgroundAntimicrobial stewardship in dentistry and antibiotic prophylaxis for tooth extraction have been areas of concern in Japan, with limited research available. MethodsThis cross-sectional study utilized the regional health insurance claims database in Japan to examine antibiotic prescription trends by dentists, including antibiotic regimens, timing of prescription, and days of supply for prophylactic antibiotic use during tooth extraction. Antibiotic prophylaxis for patients with prosthetic heart valves was also investigated. FindingsAntibiotic prescriptions by dentists decreased by 7% in 2019 compared to those in 2015, with third-generation cephalosporins still accounting for 48.5% in 2019. Amoxicillin prescription increased 3.9 times in 2019, although it only accounted for 8.4% of all antibiotic prescriptions. In 2019, amoxicillin was prescribed for 17.1% of all prophylactic antibiotics associated with tooth extraction, and 80% of prophylactic antibiotics were prescribed for 3 days or more, with 85% prescribed on the day of the procedure. However, only 60–70% of patients with prosthetic heart valves received antibiotic prophylaxis. InterpretationDespite the increasing trend after the implementation of the National Action Plan on antimicrobial resistance, the proportion of amoxicillin prescriptions in dentistry remains low. Antimicrobial stewardship issues related to long-term prescription and timing of administration of prophylactic antibiotics for tooth extraction should be addressed. Dentists must recognize the risks associated with high-risk patients with prosthetic heart valves who require antibiotic prophylaxis, and physicians providing valve replacement therapy should inform patients of the requirement for prophylaxis before invasive dental procedures.

New pharmacological agents and novel cardiovascular pharmacotherapy strategies in 2022.

Cardiovascular diseases (CVD) remain the leading cause of death worldwide and pharmacotherapy of most of them is suboptimal. Thus, there is a clear unmet clinical need to develop new pharmacological strategies with greater efficacy and better safety profiles. In this review, we summarize the most relevant advances in cardiovascular pharmacology in 2022 including the approval of first-in-class drugs that open new avenues for the treatment of obstructive hypertrophic cardiomyopathy (mavacamten), type 2 diabetes mellitus (tirzepatide), and heart failure (HF) independent of left ventricular ejection fraction (sodium-glucose cotransporter 2 inhibitors). We also dealt with fixed dose combination therapies repurposing different formulations of "old" drugs with well-known efficacy and safety for the treatment of patients with acute decompensated HF (acetazolamide plus loop diuretics), atherosclerotic cardiovascular disease (moderate-dose statin plus ezetimibe), Marfan syndrome (angiotensin receptor blockers plus β-blockers), and secondary cardiovascular prevention (i.e. low-dose aspirin, ramipril and atorvastatin), thereby filling existing gaps in knowledge, and opening new avenues for the treatment of CVD. Clinical trials confirming the role of dapagliflozin in patients with HF and mildly reduced or preserved ejection fraction, long-term evolocumab to reduce the risk of cardiovascular events, vitamin K antagonists for stroke prevention in patients with rheumatic heart disease-associated atrial fibrillation, antibiotic prophylaxis in patients at high risk for infective endocarditis before invasive dental procedures, and vutrisiran for the treatment of hereditary transthyretin-related amyloidosis with polyneuropathy were also reviewed. Finally, we briefly discuss recent clinical trials suggesting that FXIa inhibitors may have the potential to uncouple thrombosis from hemostasis and attenuate/prevent thromboembolic events with minimal disruption of hemostasis.

Safety of Omitting Preoperative Antibiotic Prophylaxis in Patients Undergoing Transurethral Ureterolithotripsy

Background: Transurethral ureterolithotripsy (TUL) is a common and highly efficient procedure for treating ureteral stones. The need for preoperative antibiotic prophylaxis to prevent post-TUL infections remains controversial. Objectives: This study aimed to investigate whether the removal of preoperative antibiotic prophylaxis affects the rate of postoperative complications in patients undergoing TUL. Methods: A total of 62 patients (aged 15-65 years) undergoing TUL between November 2021 and March 2022 were included in this controlled clinical trial. Patients were divided into two groups by the available gradual and sequential sampling methods: 33 had positive preoperative urine culture (UC), and 29 had negative preoperative UC. None of the patients in the two groups received preoperative antibiotic prophylaxis. Perioperative and postoperative outcomes, such as the operative time, stone-free rate, postoperative analgesic use, fever, urinary tract infection (UTI), and hospital stay, were reviewed in both groups. Results: Patients with positive UC were significantly older than those with negative UC (P=0.018), and had a higher BMI (P=0.016). No significant differences were observed between the two groups in most perioperative variables or postoperative outcomes (P>0.05). In addition, patients in the positive UC group had significantly more underlying diseases than the other group (P=0.022). Postoperative symptomatic UTI was found in neither of the two groups. Fever was reported in 3 (9.1%) and 1 (3.4%) patients in the positive and negative UC groups, respectively, with no statistically significant differences between the two groups (P=0.616). In the matched logistic regression model, the effect of preoperative UC on postoperative fever was not significant (P=0.40). Conclusion: The results of our study showed that prophylactic antibiotics can be eliminated at the discretion of the surgeon in patients without symptomatic positive UC.

Evaluation of clinical outcomes and treatment patterns of antibiotic prophylaxis in patients undergoing surgery in tamin ejtemaee shahriyar treatment center

Evaluation of clinical outcomes and treatment patterns of antibiotic prophylaxis in patients undergoing surgery in tamin ejtemaee shahriyar treatment center

MP16-16 POSTOPERATIVE ANTIBIOTIC PROPHYLAXIS FOR PERCUTANEOUS NEPHROLITHOTOMY AND RISK OF INFECTION: A SYSTEMATIC REVIEW AND META-ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023MP16-16 POSTOPERATIVE ANTIBIOTIC PROPHYLAXIS FOR PERCUTANEOUS NEPHROLITHOTOMY AND RISK OF INFECTION: A SYSTEMATIC REVIEW AND META-ANALYSIS Thalita Talizin, Alexandre Danilovic, Fabio Torricelli, Giovanni Marchini, Carlos Batagello, Fabio Vicentini, William Nahas, and Eduardo Mazzucchi Thalita TalizinThalita Talizin More articles by this author , Alexandre DanilovicAlexandre Danilovic More articles by this author , Fabio TorricelliFabio Torricelli More articles by this author , Giovanni MarchiniGiovanni Marchini More articles by this author , Carlos BatagelloCarlos Batagello More articles by this author , Fabio VicentiniFabio Vicentini More articles by this author , William NahasWilliam Nahas More articles by this author , and Eduardo MazzucchiEduardo Mazzucchi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003236.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is no specific recommendation for postoperative antibiotic regimen in patients undergoing percutaneous nephrolithotomy (PCNL). The aim of this study is to perform a high quality meta-analysis using only randomized controlled trials (RCT) trials to define the role of postoperative antibiotics in patients undergoing PCNL. METHODS: This review was conducted according to PRISMA (preferred reporting items for systematic reviews and meta-analyses) statement. A search for "percutaneous nephrolithotomy" and "antibiotic" was performed on EMBASE, PubMed and Web Of Science platforms, resulting in 1362 publications. We selected only RCT that compared short dose perioperative vs. postoperative antibiotic prophylaxis in patients undergoing PCNL. The PICO (population, intervention, control and outcome) was: Population - adult patients that underwent to PCNL; Intervention - postoperative antibiotic prophylaxis; Control - short dose perioperative antibiotic prophylaxis; and Outcome - systemic inflammatory response syndrome (SIRS) or sepsis and fever after PCNL. The meta-analysis protocol was registered on PROSPERO database (CRD42022361579). Risk of bias assessments were done independently by 2 of the investigators with agreement, without discrepancy. We calculated odds ratios (OR) and 95% confidence interval (CI) of each study to evaluate differences between them. Chi-squared test and I2 were used to evaluate heterogeneity. When heterogeneity was present, random effects model was used. Alpha risk was defined as <0.05. RESULTS: The final selection was seven articles with a total of 629 patients studied. Forest plots (Figure 1) evidenced there was no statistical association between use of postoperative antibiotic prophylaxis and SIRS/sepsis (OR 1.204, 95% CI 0.719 – 2.016, p=0.481). Patients who received intervention had higher fever incidence (OR 2. 048, 95% 1.038 – 4.040, p=0.039) than control group. CONCLUSIONS: We conclude that there is no benefit in the use of postoperative antibiotic prophylaxis in patients undergoing PCNL. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e208 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Thalita Talizin More articles by this author Alexandre Danilovic More articles by this author Fabio Torricelli More articles by this author Giovanni Marchini More articles by this author Carlos Batagello More articles by this author Fabio Vicentini More articles by this author William Nahas More articles by this author Eduardo Mazzucchi More articles by this author Expand All Advertisement PDF downloadLoading ...

PD34-11 ONE WEEK PREOPERATIVE ORAL ANTIBIOTICS FOR PERCUTANEOUS NEPHROLITHOTOMY REDUCE RISK OF INFECTION: A SYSTEMATIC REVIEW AND META-ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023PD34-11 ONE WEEK PREOPERATIVE ORAL ANTIBIOTICS FOR PERCUTANEOUS NEPHROLITHOTOMY REDUCE RISK OF INFECTION: A SYSTEMATIC REVIEW AND META-ANALYSIS Alexandre Danilovic, Thalita Talizin, Fabio Torricelli, Giovanni Marchini, Carlos Batagello, Fabio Vicentini, William Nahas, and Eduardo Mazzucchi Alexandre DanilovicAlexandre Danilovic More articles by this author , Thalita TalizinThalita Talizin More articles by this author , Fabio TorricelliFabio Torricelli More articles by this author , Giovanni MarchiniGiovanni Marchini More articles by this author , Carlos BatagelloCarlos Batagello More articles by this author , Fabio VicentiniFabio Vicentini More articles by this author , William NahasWilliam Nahas More articles by this author , and Eduardo MazzucchiEduardo Mazzucchi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003327.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Approximately 0.5% of the patients develop postoperative sepsis after percutaneous nephrolithotomy (PCNL). The aim of this study is to perform a high quality meta-analysis using only prospective studies to define the role of preoperative antibiotics in patients undergoing PCNL. METHODS: This review was conducted according to PRISMA (preferred reporting items for systematic reviews and meta-analyses) statement. We selected prospective studies and randomized controlled trials that compared extended to short dose preoperative antibiotic prophylaxis in patients undergoing PCNL. A search for "percutaneous nephrolithotomy" and "antibiotic" was performed on EMBASE, PubMed and Web Of Science platforms, resulting in 1362 publications. The PICO (population, intervention, control and outcome) was: Population - adult patients that underwent to PCNL; Intervention - extended dose preoperative antibiotic prophylaxis before PCNL; Control - short dose preoperative antibiotic prophylaxis before PCNL; and Outcome: systemic inflammatory response syndrome (SIRS) or sepsis, fever after PCNL and positive intraoperative urine culture and stone culture. The meta-analysis protocol was registered on PROSPERO database (CRD42022359589). Alpha risk was defined as <0.05. RESULTS: The final selection was five articles with a total of 475 patients studied. Forest plots (figure 1) evidenced that using antibiotics for 7 days in preoperative period of PCNL was a protective factor for developing SIRS/sepsis (OR 0.366, 95% CI 0.234-0.527, p<0.001). There was no statistical association between seven-day use of antibiotics and fever (OR 0.592, 95% CI 0.147–2.388, p=0.462). Patients who received intervention had lower positive intraoperative urine culture (OR 0.284, 95% CI 0.120–0.674, p=0.004) and stone culture (OR 0.351, 95% CI 0.185–0.663, p=0.001) than control group. CONCLUSIONS: We conclude that one week of prophylactic oral antibiotics based on local bacterial sensitivity pattern in patients undergoing PCNL reduces the risk of infection. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e924 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexandre Danilovic More articles by this author Thalita Talizin More articles by this author Fabio Torricelli More articles by this author Giovanni Marchini More articles by this author Carlos Batagello More articles by this author Fabio Vicentini More articles by this author William Nahas More articles by this author Eduardo Mazzucchi More articles by this author Expand All Advertisement PDF downloadLoading ...