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Acute Pyelonephritis II: Diagnostic Studies and Management

Acute Pyelonephritis II: Diagnostic Studies and Management

Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...

Urinary Tract Calculi VI: Surgical Management

Urinary Tract Calculi VI: Surgical Management

Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...

Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care

Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care

A healthcare provider can diagnose a urinary tract infection (UTI) through several methods:Medical History and Symptoms: The provider will take a detailed medical history and ask about symptoms such as frequent urination, burning sensation during urination, and lower abdominal pain.Urinalysis: A clean-catch urine sample is collected in a sterile container and tested for the presence of bacteria, white blood cells (leukocytes), nitrites, blood, and protein. The presence of leukocytes and...

Acute Kidney Injury IV: Diagnostic Studies and Prevention

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Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...

Kidney Transplant II: Surgical Procedure

Kidney Transplant II: Surgical Procedure

Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...

Urinary Tract Calculi III: Medical Management

Urinary Tract Calculi III: Medical Management

The diagnosis of renal calculi involves several imaging techniques, including non-contrast CT scans and ultrasound. These methods help visualize kidney stones, assess their size and location, and detect possible obstructions. Additionally, Measuring urine pH is useful for diagnosing specific stone types, such as struvite (alkaline pH) and uric acid stones (acidic pH). Cystine stones are primarily linked to cystinuria, a genetic condition. A urinalysis helps detect blood in the urine (hematuria)...

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Updated: Jul 13, 2025

Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection

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Antimicrobial Prophylaxis for Percutaneous Nephrolithotomy: Contemporary Practice Patterns.

Jeffrey Johnson¹, Prakash Gorroochurn², Miyad Movassaghi³

¹Department of Urology, Weill Cornell Medical Center, New York, New York, USA.

Journal of Endourology

|October 13, 2023

Summary

This summary is machine-generated.

Nearly half of urologists do not follow American Urological Association guidelines for antibiotic prophylaxis during percutaneous nephrolithotomy (PCNL). Metronidazole and aztreonam are rarely used, indicating a need for updated recommendations.

Keywords:

antibiotic prophylaxis kidney stones percutaneous nephrolithotomy

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Area of Science:

Urology
Infectious Disease
Antimicrobial Stewardship

Background:

The American Urological Association (AUA) provides guidelines for antimicrobial prophylaxis in percutaneous nephrolithotomy (PCNL).
Recent evidence suggests these guidelines may not reflect current clinical practice.
Endourologists' adherence to AUA prophylaxis recommendations for PCNL is not well-documented.

Purpose of the Study:

To assess endourologists' adherence to the AUA Best Practice Statement on antimicrobial prophylaxis for PCNL.
To identify prescribing patterns and factors influencing antibiotic selection during PCNL.

Main Methods:

A 24-question survey was distributed to members of the Endourological Society.
The survey assessed adherence to AUA guidelines and current antibiotic prescribing habits.
Logistic regression analyses were performed to identify predictors of adherence.

Main Results:

Only 51.4% of endourologists reported following the AUA guidelines for uncomplicated PCNL prophylaxis.
Metronidazole and aztreonam were rarely used as first-line agents (90.9% and 83.6% "never" used, respectively).
Prescribing patterns for duration and choice of antibiotics varied significantly, with cephalosporins being the most common choice.

Conclusions:

A substantial proportion of endourologists do not adhere to current AUA guidelines for PCNL antimicrobial prophylaxis.
Current first-line antibiotic recommendations, specifically metronidazole and aztreonam, appear underutilized.
Updated guidelines are needed to align with contemporary practices, antimicrobial stewardship principles, and emerging evidence.