#WCE2014 - Antimicrobial utilization prior to endourological surgery for urolithiasis: Endourological Society survey results - Interview

TAIPEI, TAIWAN (UroToday.com) - Introduction and Objectives: To determine variations in antimicrobial use prior to endourological surgery for urolithiasis and to correlate these variations to site, pattern and volume of clinical practice.

Methods: An online survey was distributed by e-mail to members of the Endourologic Society. The survey queried the duration of antimicrobial therapy prior to uncomplicated ureteroscopy (URS) and percutaneous nephrolithotomy (PNL) with negative and asymptomatic positive pre-operative urine cultures.

Results: The response rate was 18.5% with 369 responders (40% from U.S., 61% academic and 64% endourology fellowship trained). The majority of respondents reported giving a single perioperative dose in patients with a negative urine culture (71% and 59% prior to URS and PNL; respectively). In patients with positive cultures, there were more heterogeneous responses. In presence of positive culture prior to URS: 13% preferred single perioperative dose, 29% preferred 1–3 days, 46% preferred 4–7 days and 12% preferred > 7 days of antibiotics before the procedure. In presence of positive culture prior to PNL: 11% preferred single perioperative dose, 24% preferred 1–3 days, 49% preferred 4–7 days and 16 % preferred > 7 days. There were significant variations in antimicrobial utilization prior to endourological management by geographical location of practice (p < 0.05).

Conclusions: There are considerable variations in antimicrobial utilization prior to endourological surgery for urolithiasis worldwide. According to current guidelines, almost 1/3 of urologists are over-utilizing antibiotics prior to stone management in patients with negative cultures. Well-designed prospective randomized studies are needed to guide appropriate duration of antibiotics in patients with positive cultures before these procedures.

Source of Funding: None

Presented by Ramy Youssef,^{1, 4} Richard Shin,¹ Fernando Cabrera1, Adam Kaplan,^{1, 4} Andreas Neisius,⁵ Charles Scales,^{1, 6} Roger Sur,³ Anika Ackerman,¹ Michael Ferrandino,¹ Brien Eisner,² Glenn Preminger,¹ and Michael Lipkin¹ at the 32nd World Congress of Endourology & SWL - September 3 - 7, 2014 - Taipei, Taiwan

¹Duke University Medical Center, USA
²Massachusetts General Hospital, Harvard Medical School, USA
³UC San Diego Health System, USA
⁴University of California, Irvine, USA
⁵Universitatsmedizin Mainz, Germany
⁶Duke Clinical Research Institute, USA