A Randomized Controlled Trial of Preoperative Prophylactic Antibiotics for Percutaneous Nephrolithotomy in Moderate to High Infectious Risk Population: A Report from the EDGE Consortium

Roger L. Sur, Amy E. Krambeck, Tim Large, Seth K. Bechis, David F. Friedlander, Manoj Monga, Ryan S. Hsi, Nicole L. Miller, Ben H. Chew, Dirk Lange, Bodo Knudsen, Michael W. Sourial, Mitchell R. Humphreys, Karen L. Stern, Ojas Shah, Joel E. Abbott, Garen Abedi

Research output: Contribution to journalArticlepeer-review

Abstract

PURPOSE: Postoperative infectious related complications are not uncommon after percutaneous nephrolithotomy. Previously, we noted that 7 days of antibiotics did not decrease sepsis rates compared to just perioperative antibiotics in a low risk percutaneous nephrolithotomy population. This study aimed to compare the same regimens in individuals at moderate to high risk for sepsis undergoing percutaneous nephrolithotomy. MATERIALS AND METHODS: Patients were prospectively randomized in this multi-institutional study to either 2 days or 7 days of preoperative antibiotics. Enrolled patients had stones requiring percutaneous nephrolithotomy and had either a positive preoperative urine culture or existing indwelling urinary drainage tube. Primary outcome was difference in sepsis rates between the groups. Secondary outcomes included rate of nonseptic bacteriuria, stone-free rate and length of stay. RESULTS: A total of 123 patients at 7 institutions were analyzed. There was no difference in sepsis rates between groups on univariate analysis. Similarly, there were no differences in nonseptic bacteriuria, stone-free rate and length of stay. On multivariate analysis, 2 days of antibiotics increased the risk of sepsis compared to 7 days of antibiotics (OR 3.1, 95% CI 1.1-8.9, p=0.031). Patients receiving antibiotics for 2 days had higher rates of staghorn calculus than the 7-day group (58% vs 32%, p=0.006) but post hoc subanalysis did not demonstrate increased sepsis in the staghorn only group. CONCLUSIONS: Giving 7 days of preoperative antibiotics vs 2 days decreases the risk of sepsis in moderate to high risk percutaneous nephrolithotomy patients. Future guidelines should consider infectious risk stratification for percutaneous nephrolithotomy antibiotic recommendations.

Original languageEnglish (US)
Pages (from-to)1379-1386
Number of pages8
JournalThe Journal of urology
Volume205
Issue number5
DOIs
StatePublished - May 1 2021
Externally publishedYes

Keywords

  • anti-bacterial agents
  • nephrolithiasis
  • nephrolithotomy
  • percutaneous
  • sepsis
  • urolithiasis

ASJC Scopus subject areas

  • Urology

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