Are prophylactic antibiotics necessary in patients with preoperative sterile urine undergoing ureterorenoscopic lithotripsy?

Abstract

OBJECTIVE:

To compare the efficacy of prophylactic antibiotics in reducing post-surgical infections in patients undergoing ureterorenoscopic lithotripsy (URSL).

PATIENTS AND METHODS:

The study was a double-blind, prospective, randomized controlled trial. Between 2009 and 2012, 212 patients with preoperative sterile urine undergoing URSL were randomly allocated, in a ratio of 1:1:1:1, to receive prophylactic antibiotics with single-dose i.v. cefazolin (1 g), ceftriaxone (1 g) or oral levofloxacin (500 mg), or no treatment (control group), respectively. Urine analysis and urine cultures were obtained between postoperative days 5 and 7. Pyuria was defined as ≥10 white blood cells/high power field. Significant bacteriuria was defined as ≥100,000 colony-forming units uropathogens/mL. Febrile urinary tract infection (fUTI) was defined as a body temperature of 38.5 °C with pyuria or significant bacteriuria ≤7 days after surgery.

RESULTS:

In total, 206 patients were eligible for analysis. The rates of postoperative pyuria were significantly lower in patients with prophylaxis than in the control group (48.4 vs 64.7%, P = 0.04). Patients receiving prophylaxis with levofloxacin and ceftriaxone had a significantly lower risk of pyuria compared with the control group (52.0 and 36.5 vs 64.7%, respectively; P < 0.05). The rates of bacteriuria and fUTI tended to be lower in patients with prophylaxis, although the difference was not significant (4.5 vs 11.8%, P = 0.09, 1.3 vs 5.9%, P = 0.09). There was no significant difference in rates of bacteriuria and fUTI between the four groups. Patients with proximal stones had a higher risk of developing postoperative fUTI (odds ratio 9.35; P = 0.03).

CONCLUSION:

Antibiotic prophylaxis significantly reduces the incidence of pyuria after URSL and tends to diminish the risk of bacteriuria and fUTI.

• Authors: Cheng-Hsing Hsieh, Stephen Shei-Dei Yang, Chia-Da Lin, Shang-Jen Chang
• Journal: BJU international (BJU Int) Vol. 113 Issue 2 Pg. 275-80 (Feb 2014) ISSN: 1464-410X [Electronic] England
• PMID: 24127851 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
• Copyright: © 2013 The Authors. BJU International © 2013 BJU International.

Chemical References

• Anti-Infective Agents, Urinary
• Levofloxacin
• Ceftriaxone
• Cefazolin

Topics

• Anti-Infective Agents, Urinary (therapeutic use)
• Antibiotic Prophylaxis
• Bacteriuria (microbiology)
• Cefazolin (therapeutic use)
• Ceftriaxone (therapeutic use)
• Double-Blind Method
• Female
• Fever (prevention & control)
• Humans
• Levofloxacin (therapeutic use)
• Lithotripsy (adverse effects, methods)
• Male
• Middle Aged
• Odds Ratio
• Postoperative Complications (microbiology, prevention & control)
• Practice Guidelines as Topic
• Preoperative Care
• Prospective Studies
• Pyuria (prevention & control)
• Treatment Outcome
• Ureteroscopy (adverse effects, methods)
• Urinary Tract Infections (complications, microbiology, prevention & control)