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Antibiotic prophylaxis in flexible ureterorenoscopy with negative urine culture

Daniela María Méndez-Guerrero1, Christian Buitrago-Carrascal2, Andrés Felipe Puentes-Bernal2

  • 1Universidad del Rosario Bogotá Colombia.

BJUI Compass
|October 11, 2023
PubMed
Abstract

Insights

Extended antibiotic prophylaxis for flexible ureterolithotomy (fURS) increases the risk of lower urinary tract infections (UTI) and multidrug-resistant bacteria (MDRB) in patients with negative urine cultures. Standard prophylaxis is recommended to reduce these infectious complications.

Area of Science:

  • Urology
  • Infectious Diseases
  • Surgical Prophylaxis

Background:

  • Nosocomial bacterial infections pose a significant threat, necessitating optimized antibiotic strategies.
  • Flexible ureterolithotomy (fURS) is a common procedure for kidney stones, but infectious complications can occur.
  • The role of extended antibiotic prophylaxis (EP) versus standard antibiotic prophylaxis (SP) in preventing infections after fURS in patients with negative urine cultures (UC) requires clarification.

Purpose of the Study:

  • To compare the incidence of infectious complications between patients undergoing fURS with negative UC who received EP versus SP.
  • To identify differences in postoperative urinary tract infections (UTIs), including lower UTIs, upper UTIs, and sepsis.
  • To assess the risk of multidrug-resistant bacteria (MDRB) isolation in postoperative UCs based on prophylaxis type.

Main Methods:

  • Retrospective, observational, analytical cohort study design.
  • Inclusion of patients who underwent successful fURS for stones <20 mm with complete data.
  • Comparison of infectious complication rates between EP and SP groups.

Main Results:

  • Overall complication rate was 10.3%, with 7.2% experiencing postoperative urinary infection.
  • Lower UTIs were significantly more frequent in the EP group (6.8% vs. 2.7%, RR=2.8, p=0.030).
  • A higher risk of MDRB isolation was observed in the EP group (RR=3.1, p=0.009).

Conclusions:

  • Extended antibiotic prophylaxis for fURS in patients with negative UC increases the risk of lower UTIs and MDRB.
  • No significant difference in upper UTI or sepsis rates was found between EP and SP groups.
  • Standard 60-minute preoperative antibiotic prophylaxis is recommended to minimize infectious complications.
Keywords:
antibioticsbacteriainfectionssepsisurolithiasis

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