THE EFFECTIVENESS OF METAPHYLAXIS OF NEPHROLITHIASIS DURING PERCUTANEOUS NEPHROLITHOTRIPSY: A SYSTEMATIC REVIEW AND...

Infected kidney stones, particularly struvite and carbonate-apatite calculi, pose a serious medical challenge due to recurrent urinary tract infections, rising antibiotic resistance, and complications following percutaneous nephrolithotripsy (PCNL).

To assess the effectiveness of metaphylaxis of infected kidney stones, investigate their composition, analyse antibiotic resistance, and determine the incidence of infectious complications after percutaneous nephrolithotripsy.

A comprehensive literature review was performed by searching PubMed, Scopus, and the Cochrane Central Register of Controlled Trials for publications between 2014 and 2024. The search strategy was built around key phrases such as 'infected kidney stones,' 'metaphylaxis,' 'antibiotic resistance,' 'percutaneous nephrolithotripsy,' and 'struvite stones.' Clinical trials, cohort and case-control studies with at least 20 participants were included; animal studies and case reports were excluded. Study selection was conducted by two independent reviewers. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale.

Forty-seven studies from 23 countries (n=8342) were analysed. Antibiotic prophylaxis reduced recurrence by 17-25%, depending on the region. Struvite stones accounted for 67.3%, with associations to Proteus mirabilis (38.4%) and Escherichia coli (29.6%). Antibiotic resistance reached 43.2%, with peaks for ampicillin (71%) and ciprofloxacin (48%). Complications after PCNL occurred in 12-28% of cases, including sepsis (3.4%) and pyonephrosis (7.8%). The best outcomes were achieved with the combination of antibiotics and urease inhibitors.

Comprehensive metaphylaxis adapted to local sensitivity profiles significantly reduces the risk of recurrence. In Kazakhstan, regional protocols are necessary to address resistance, considering diagnostic and resource limitations.