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Miniaturized percutaneous Nephrolithotomy without antibiotic prophylaxis: a single institution experience
M J Schnabel1, B Rosenhammer2, M Steckermeier2
1Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Landshuter Str. 65, 93053, Regensburg, Germany. mschnabel@caritasstjosef.de.
International Urology and Nephrology
|April 3, 2021
Summary
Routine antibiotic prophylaxis may be safely omitted in select patients undergoing miniaturized percutaneous nephrolithotomy (mPCNL). This approach significantly reduces antibiotic usage without increasing postoperative complications for eligible patients without urinary tract infection (UTI).
Area of Science:
- Urology
- Infectious Diseases
- Antibiotic Stewardship
Background:
- Antibiotic prophylaxis is standard for percutaneous nephrolithotomy (PCNL).
- Antibiotic stewardship principles encourage judicious antibiotic use.
- Miniaturized PCNL (mPCNL) may alter complication profiles and antibiotic needs.
Purpose of the Study:
- To evaluate the feasibility of withholding routine antibiotic prophylaxis in patients undergoing mPCNL.
- To assess postoperative complication rates in mPCNL patients without preoperative urinary tract infection (UTI).
Main Methods:
- Retrospective, monocentric study comparing mPCNL patients with and without antibiotic prophylaxis (NoPAP vs. PAP).
- Patients in the NoPAP group had unremarkable preoperative urine cultures and received no prophylaxis.
- Outcomes focused on postoperative fever and Clavien complications; logistic regression identified risk factors.
Main Results:
- No significant difference in postoperative fever (8% NoPAP vs. 9% PAP) or Clavien 1-3 complications (33% NoPAP vs. 41% PAP) between groups.
- Staghorn stones and infectious stone components were risk factors for fever.
- Routine prophylaxis omission reduced antibiotic usage from 100% to 9%.
Conclusions:
- Routine antibiotic prophylaxis may be unnecessary for mPCNL patients with negative preoperative urine cultures, no staghorn stones, and no history of recurrent UTI or infectious stones.
- This strategy significantly reduces overall antibiotic consumption.
- Prospective validation is recommended.
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