Category: Clinical Stones: Outcomes

MP8-8 - Infectious Complications Following Ureteroscopy in Patients Treated with Alternative Antimicrobial Prophylaxis: a Prospective Trial

Fri, Sep 21
10:00 AM - 12:00 PM

Introduction & Objective :

According to the AUA Best Practice Statement (BPS), fluoroquinolones (FQs) are an “antimicrobial of choice” for ureteroscopy. However, FQ resistance is on the rise. Our local antibiogram from 2013 reports that Escherichia Coli resistance rates are 57% in patients undergoing endoscopic procedures. Additionally, with three “black box warnings”, FQs have been relegated to an alternative treatment option for uncomplicated urinary tract infection (UTI). At our institution, FQ prophylaxis is no longer used as a first-line agent and we employ “alternative antimicrobials” as recommended by the BPS. We therefore sought to determine infectious complication rates associated with this alternative antimicrobial regimen after ureteroscopy.

Methods :

With IRB approved protocol, consecutive adult patients who underwent ureteroscopy for nephrolithiasis were enrolled between June 2016 and January 2017. Exclusion criteria included ureteroscopy for non-nephrolithiasis indications and patients with an active UTI or positive pre-operative urine culture. Patients received alternative antimicrobial prophylaxis: ampicillin (vancomycin if penicillin allergic) and gentamicin (5 mg/kg ideal body weight) (ceftriaxone if eGFR2 <60 mL/min/1.73m2) within 60 minutes of surgical intervention for a duration of < 24 hours. Previous urine cultures were also used to guide antibiotic choice. 30-day infectious complications and readmission rates were reported.

Results :

76 subjects were enrolled but only 60 patients completed the trial. Table 1 shows antibiotic prophylaxis. Of patients who had a post-operative urine culture, 84.1% (37/44) were negative. 11 patients (18.3%) had complications within 30 days of surgery, of which 5 (8.33%) were infectious in etiology: 3 pyelonephritis, 2 symptomatic UTIs. Readmission occurred in 4 (6.7%) cases.

Conclusions : Using “alternative antimicrobials” for prophylaxis, we not only demonstrated an infectious complication rate consistent with published rates, but more importantly conducted a level 2b prospective trial. The generalizability of this data is strengthened by the effectiveness trial design. This data is particularly valuable as it validates AUA Best Practice Statement recommendations.

Seth K. Bechis

Assistant Professor
UC San Diego Department of Urology
San Diego, California

Seth Bechis, MD, MS, is a urologist who cares for patients with diseases of the urinary tract, including kidney stones, benign prostatic hyperplasia (BPH) or enlarged prostate, and men’s health issues. As member of the comprehensive Kidney Stone Center at UC San Diego Health, he has a special interest in advanced surgical treatment, medical prevention and research on kidney stone disease. He also performs advanced procedures for BPH as well as robotic surgery.

Dr. Bechis completed fellowship training in laparoscopy/robotics and endourology at UC San Diego School of Medicine, and residency training at Harvard Medical School, Massachusetts General Hospital. He earned his medical degree from the University of California, San Francisco School of Medicine and holds additional Master of Science training in biomedical research, also from UCSF. Biomedical research (or experimental medicine) focuses on ways to prevent and treat diseases. It is a key component of the Kidney Stone Center, which offers patients access to clinical trials that examine newly developed therapies and procedures.

Prior to joining UC San Diego Health, Dr. Bechis worked at Massachusetts General Hospital and Harvard Medical School.

Dimitri Papagiannopoulos

Fellow Physician
University of California San Diego
San Diego, California

Thomas DiPina

Research Associate
UC San Diego Department of Urology
San Diego, California

Brian Nguyen

Medical Student
University of California San Diego
San Diego, California

Roger L. Sur

Professor of Urology
UC San Diego Department of Urology
San Diego, California