Category: Clinical Stones: PCNL

MP7-20 - Prospective Randomized Trial of Antibiotic Prophylaxis Duration for Percutaneous Nephrolithotomy in Low-Risk Patients

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

Introduction & Objective :

Although the American Urologic Association (AUA) recommends 24 hours or less of perioperative antibiotics for percutaneous nephrolithotomy (PCNL), practice patterns vary regarding duration of antibiotic therapy. We aimed to compare the efficacy of 24-hour antibiotic coverage versus short-course protocol of antibiotic prophylaxis for PCNL.

Methods :

Low risk patients with a sterile pre-operative urine culture undergoing PCNL were randomized to antibiotics for 24 hours (24H) or until external urinary catheters were removed (CR). Patients were given a 1st generation cephalosporin, or ciprofloxacin, in patients with penicillin allergy. Exclusion criteria included age 1 week, multi-stage procedure, immunosuppression, pregnancy, multiple antibiotic allergies, and patients who are breastfeeding. Descriptive and Fisher’s exact test were used to compare infection-related events and complication rates within 30 days of the procedure between groups<./p>

Results : Ninety-eight patients were randomized to either 24H (n=49) or CR (n=49) and analyzed. Mean duration of antibiotic administration was 20.6 hours and 34.0 hours in the 24H and CR groups (p=0.04), respectively. Age, comorbidities, stone size, operative time, number of punctures, dilations, and proportion of “tubeless” procedures were similar between groups.  There were no differences in febrile episodes, rates of systemic inflammatory response syndrome, bacteremia, or culture-proven post-operative urinary tract infection between the 24H and CR groups (see Table). Overall complication rates were similar between groups. In a subgroup analysis which excluded “tubeless” patients (24 and 29 patients in 24H and CR groups, respectively), no differences were seen in postoperative outcomes.

Conclusions :

In a randomized, prospective study, we found that a 24-hour protocol for antibiotic prophylaxis is not associated with increased risk of infection-related events compared to giving antibiotics until external catheters are removed in patients with low infectious risk undergoing PCNL.

Luke Griffiths

Medical Student
The Smith Institute for Urology, Hofstra/Northwell
Franklin Square, New York

Patrick Samson

Endourology Fellow
University of Washington
Seattle, Washington

Samir Derisavifard

FPMRS Fellow
Cleveland Clinic
Cleveland, Ohio

Geoffrey Gaunay

Lancaster Urology
Lancaster, Pennsylvania

David A. Leavitt

Henry Ford Health System
Detroit, Michigan

Bradley Morganstern

New Hyde Park, New York

Arthur Smith

Chairman Emeritus
The Smith Institute for Urology, Hofstra/Northwell
New Hyde Park, New York

David Hoenig

Professor of Urology
The Smith Institute for Urology, Hofstra/Northwell
New Hyde Park, New York

Zeph Okeke

Endourology Fellowship Director
The Smith Institute for Urology, Hofstra/Northwell
New Hyde Park, New York