A Randomized Controlled Trial of Preoperative Prophylactic Antibiotics for Percutaneous Nephrolithotomy in Moderate to High Infectious Risk Population: A Report from the EDGE Consortium.

Abstract

PURPOSE:

Postoperative infectious related complications are not uncommon after percutaneous nephrolithotomy. Previously, we noted that 7 days of antibiotics did not decrease sepsis rates compared to just perioperative antibiotics in a low risk percutaneous nephrolithotomy population. This study aimed to compare the same regimens in individuals at moderate to high risk for sepsis undergoing percutaneous nephrolithotomy.

MATERIALS AND METHODS:

Patients were prospectively randomized in this multi-institutional study to either 2 days or 7 days of preoperative antibiotics. Enrolled patients had stones requiring percutaneous nephrolithotomy and had either a positive preoperative urine culture or existing indwelling urinary drainage tube. Primary outcome was difference in sepsis rates between the groups. Secondary outcomes included rate of nonseptic bacteriuria, stone-free rate and length of stay.

RESULTS:

A total of 123 patients at 7 institutions were analyzed. There was no difference in sepsis rates between groups on univariate analysis. Similarly, there were no differences in nonseptic bacteriuria, stone-free rate and length of stay. On multivariate analysis, 2 days of antibiotics increased the risk of sepsis compared to 7 days of antibiotics (OR 3.1, 95% CI 1.1-8.9, p=0.031). Patients receiving antibiotics for 2 days had higher rates of staghorn calculus than the 7-day group (58% vs 32%, p=0.006) but post hoc subanalysis did not demonstrate increased sepsis in the staghorn only group.

CONCLUSIONS:

Giving 7 days of preoperative antibiotics vs 2 days decreases the risk of sepsis in moderate to high risk percutaneous nephrolithotomy patients. Future guidelines should consider infectious risk stratification for percutaneous nephrolithotomy antibiotic recommendations.

• Authors: Roger L Sur, Amy E Krambeck, Tim Large, Seth K Bechis, David F Friedlander, Manoj Monga, Ryan S Hsi, Nicole L Miller, Ben H Chew, Dirk Lange, Bodo Knudsen, Michael W Sourial, Mitchell R Humphreys, Karen L Stern, Ojas Shah, Joel E Abbott, Garen Abedi
• Journal: The Journal of urology (J Urol) Vol. 205 Issue 5 Pg. 1379-1386 (05 2021) ISSN: 1527-3792 [Electronic] United States
• PMID: 33369488 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Aged
• Aged, 80 and over
• Antibiotic Prophylaxis (methods)
• Female
• Humans
• Kidney Calculi (surgery)
• Male
• Middle Aged
• Nephrolithotomy, Percutaneous
• Postoperative Complications (epidemiology, microbiology, prevention & control)
• Prospective Studies
• Risk Assessment
• Sepsis (epidemiology, prevention & control)
• Single-Blind Method
• Time Factors
• Young Adult