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Comparative Effectiveness Randomized Clinical Trial Using Next-generation Microbial Sequencing to Direct Prophylactic

Michael A Liss1, Kelly R Reveles2,3, Craig D Tipton4,5

  • 1Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA.

European Urology Open Science
|November 29, 2023
PubMed
Summary
This summary is machine-generated.

Next-generation sequencing (NGS) microbial profiling guided antibiotic prophylaxis to significantly reduce postoperative urinary infections in patients undergoing urologic stone interventions. This approach improved antibiotic selection and decreased infection rates compared to standard care.

Keywords:
InfectionKidney stoneLithotripsyMicrobiomeNext-generation sequencing

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Area of Science:

  • Urology
  • Infectious Diseases
  • Microbiology

Background:

  • Next-generation sequencing (NGS) offers enhanced sensitivity for detecting urinary pathogens.
  • Standard urine cultures may miss low-level or fastidious organisms.

Purpose of the Study:

  • To evaluate if NGS microbial profiling can guide antibiotic prophylaxis and reduce infections compared to the standard of care.
  • To assess the impact of NGS on antibiotic selection and patient outcomes in urologic stone interventions.

Main Methods:

  • A prospective randomized controlled trial involving patients undergoing urologic stone interventions.
  • Urine samples were analyzed using both standard culture and NGS diagnostics.
  • Infectious disease pharmacists recommended prophylactic antimicrobial regimens based on NGS findings.

Main Results:

  • NGS-guided prophylaxis significantly reduced postsurgical urinary infection risk (7.1% reduction in mITT analysis, p=0.045).
  • NGS altered antibiotic distribution (p=0.025), with poor adherence to NGS findings linked to increased infection odds (OR=5.9, p=0.046).
  • Women had higher infection odds (OR=10, p=0.03) and distinct microbial profiles (p<0.001).

Conclusions:

  • Urinary microbial NGS-guided antibiotic prophylaxis improves antibiotic selection and reduces healthcare-associated urinary infections before urologic stone lithotripsy.
  • Treatment efficacy may depend on adherence to the recommended NGS-guided protocol.
  • NGS holds potential for individualized antibiotic use in urologic procedures.