1. Is extended preoperative antibiotic prophylaxis for high-risk patients necessary before percutaneous nephrolithotomy?
- Author
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Potretzke AM, Park AM, Bauman TM, Larson JA, Vetter JM, Benway BM, and Desai AC
- Subjects
- Adult, Aged, Aged, 80 and over, Drug Administration Schedule, Female, Humans, Male, Middle Aged, Nephrolithotomy, Percutaneous methods, Postoperative Care methods, Retrospective Studies, Systemic Inflammatory Response Syndrome etiology, Unnecessary Procedures, Urinary Tract Infections etiology, Urinary Tract Infections prevention & control, Urolithiasis pathology, Anti-Bacterial Agents administration & dosage, Antibiotic Prophylaxis methods, Nephrolithotomy, Percutaneous adverse effects, Systemic Inflammatory Response Syndrome prevention & control, Urolithiasis surgery
- Abstract
Purpose: The goal of this study was to compare the rate of systemic inflammatory response syndrome (SIRS) in high-risk patients undergoing percutaneous nephrolithotomy (PCNL) between patients who received 7, 2, or 0 days of preoperative antibiotics., Materials and Methods: We retrospectively reviewed a series of consecutive PCNLs performed at our institution. Patients with infected preoperative urine cultures were excluded. High-risk patients were defined as those with a history of previous urinary tract infection (UTI), hydronephrosis, or stone size ≥2 cm. Patients were treated with 7, 2, or 0 days of preoperative antibiotic prophylaxis prior to PCNL. All patients received a single preoperative dose of antibiotics within 60 minutes of the start of surgery. Fisher exact test was used to compare the rate of SIRS by preoperative antibiotic length., Results: Of the 292 patients identified, 138 (47.3%) had sterile urine and met high-risk criteria, of which 27 (19.6%), 39 (28.3%), and 72 (52.2%) received 7, 2, and 0 days of preoperative antibiotics, respectively. The 3 groups were similar in age, sex, and duration of surgery (p>0.05). There was no difference in the rate of SIRS between the groups, with 1 of 27 (3.7%), 2 of 39 (5.1%) and 3 of 72 patients (4.2%) meeting criteria in the 7, 2, and 0 days antibiotic groups (p=~1)., Conclusions: Extended preoperative antibiotic prophylaxis was not found to reduce the risk of SIRS after PCNL in our institutional experience of high-risk patients. For these patients, a single preoperative dose of antibiotics is sufficient., Competing Interests: The authors have nothing to disclose.
- Published
- 2016
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