Prospective Randomized Trial of Antibiotic Prophylaxis Duration for Percutaneous Nephrolithotomy in Low-Risk Patients.
Academic Article
Overview
abstract
Introduction Post operative infection and sepsis account for the most common complication following Percutaneous nephrolithotomy, with numbers as high as 14% in low-risk patients. Although the American Urologic Association (AUA) recommends 24 hours or less of perioperative antibiotics for percutaneous nephrolithotomy (PCNL), practice patterns vary regarding duration of antibiotic therapy. We aimed to compare the efficacy of 24-hour antibiotic coverage versus short-course protocol of antibiotic prophylaxis for PCNL. Methods Low-risk patients with a sterile pre-operative urine culture undergoing PCNL were prospectively randomized to antibiotics for 24 hours (24Hr) or until external urinary catheters were removed (CR). Patients were given a 1st generation cephalosporin, or ciprofloxacin in patients with penicillin allergy. Exclusion criteria included age <18 years, receiving antibiotics immediately prior to the procedure, history of urosepsis, presence of indwelling catheter >1 week, multi-stage procedure, immunosuppression, pregnancy, multiple antibiotic allergies, and patients who are breastfeeding. Results Ninety-eight patients were randomized to either 24Hr (n=49) or CR (n=49) and analyzed. Mean duration of antibiotic administration was 20.6 hours and 34.0 hours in the 24Hr and CR groups (p=0.04), respectively. Age, comorbidities, stone size, operative time, number of punctures, dilations, and proportion of "tubeless" procedures were similar between groups. There were no differences in febrile episodes, rates of systemic inflammatory response syndrome, bacteremia, or culture-proven post-operative urinary tract infection between the 24Hr and CR groups. Overall complication rates were similar between groups. In a subgroup analysis which excluded "tubeless" patients (24 and 29 patients in 24Hr and CR groups, respectively), no differences were seen in postoperative outcomes. Conclusions In a randomized, prospective study, we found that a 24-hour protocol for antibiotic prophylaxis is not associated with increased risk of infection-related events compared to giving antibiotics until external catheters are removed in patients with low infectious risk undergoing PCNL.
