OBJECTIVE: To compare the efficacy of prophylactic antibiotics in reduction of post-surgical infections in patients undergoing ureterorenoscopic lithotripsy (URSL).
METHODS: The study is a double-blind, prospective, randomized controlled trial. Between 2009 and 2012, 212 patients with preoperative sterile urine undergoing URSL were randomly allocated by the randomization ratio of 1:1:1:1 to receive prophylactic antibiotics with single-dose intravenous cefazolin (1gm), ceftriaxone (1gm), oral levofloxacin (500mg) or no treatment (control group), respectively. Urine analysis and urine cultures were obtained between postoperative day 5 and 7. Pyuria was defined as ≧10 WBC/hpf. Significant bacteriuria was defined as ≧105cfu uropathogens/ml. Febrile urinary tract infection (fUTI) was defined as body temperature of 38.5 Celsius degree with pyuria or significant bacteriuria within 7 days post-operatively.
RESULTS: In total, 206 patients were eligible for analysis. The rates of postoperative pyuria were significantly lower in patients with prophylaxis than the control group (48.4% vs. 64.7%, p=0.04). Patients receiving prophylaxis with levofloxacin and ceftriaxone were subjected to significantly lower risks of pyuria compared with the control group (52.0% and 36.5% vs. 64.7%, p< 0.05). The rates of bacteriuria and fUTI tended to be lower in patients with prophylaxis though not statistically 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. Proximal stones posed a higher risk of developing post-operative fUTI (OR=9.35, p=0.03).
CONCLUSIONS: Antibiotic prophylaxis significantly reduces the incidence of pyuria following URSL and tends to diminish the risk of bacteriuria and fUTI.
Written by:
Hsieh CH, Yang SS, Lin CD, Chang SJ. Are you the author?
Division of Urology, Taipei Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, New Taipei, Taiwan, and Medical College of Buddhist Tzu Chi University, Hualien, Taiwan.
Reference: BJU Int. 2013 Oct 15. Epub ahead of print.
doi: 10.1111/bju.12502
PubMed Abstract
PMID: 24127851
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