Is extended preoperative antibiotic prophylaxis for high-risk patients necessary before percutaneous nephrolithotomy?

Autor: Potretzke AM; Division of Urology, Washington University School of Medicine, Saint Louis, MO, USA., Park AM; Division of Urology, Washington University School of Medicine, Saint Louis, MO, USA., Bauman TM; Division of Urology, Washington University School of Medicine, Saint Louis, MO, USA., Larson JA; Division of Urology, Washington University School of Medicine, Saint Louis, MO, USA., Vetter JM; Division of Urology, Washington University School of Medicine, Saint Louis, MO, USA., Benway BM; Urology Academic Practice, Cedars-Sinai Medical Center, Los Angeles, CA, USA., Desai AC; Division of Urology, Washington University School of Medicine, Saint Louis, MO, USA.
Jazyk: angličtina
Zdroj: Investigative and clinical urology [Investig Clin Urol] 2016 Nov; Vol. 57 (6), pp. 417-423. Date of Electronic Publication: 2016 Oct 24.
DOI: 10.4111/icu.2016.57.6.417
Abstrakt: 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.
Databáze: MEDLINE
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