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Are prophylactic antibiotics necessary in patients with preoperative sterile urine undergoing ureterorenoscopic lithotripsy?
Author(s) -
Hsieh ChengHsing,
Yang Stephen SheiDei,
Lin ChiaDa,
Chang ShangJen
Publication year - 2014
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12502
Subject(s) - medicine , antibiotics , urine , lithotripsy , surgery , urology , microbiology and biotechnology , biology
Objective To compare the efficacy of prophylactic antibiotics in reducing post‐surgical infections in patients undergoing ureterorenoscopic lithotripsy ( URSL ).Patients and Methods The study was a double‐blind, prospective, randomized controlled trial. Between 2009 and 2012, 212 patients with preoperative sterile urine undergoing URSL were randomly allocated, in a ratio of 1:1:1:1, to receive prophylactic antibiotics with single‐dose i.v. cefazolin (1 g), ceftriaxone (1 g) or oral levofloxacin (500 mg), or no treatment (control group), respectively. Urine analysis and urine cultures were obtained between postoperative days 5 and 7. Pyuria was defined as ≥10 white blood cells/high power field. Significant bacteriuria was defined as ≥100,000 colony‐forming units uropathogens/mL. Febrile urinary tract infection ( fUTI ) was defined as a body temperature of 38.5 °C with pyuria or significant bacteriuria ≤7 days after surgery.Results In total, 206 patients were eligible for analysis. The rates of postoperative pyuria were significantly lower in patients with prophylaxis than in the control group (48.4 vs 64.7%, P = 0.04). Patients receiving prophylaxis with levofloxacin and ceftriaxone had a significantly lower risk of pyuria compared with the control group (52.0 and 36.5 vs 64.7%, respectively; P < 0.05). The rates of bacteriuria and fUTI tended to be lower in patients with prophylaxis, although the difference was not significant (4.5 vs 11.8%, P = 0.09, 1.3 vs 5.9%, P = 0.09). There was no significant difference in rates of bacteriuria and fUTI between the four groups. Patients with proximal stones had a higher risk of developing postoperative fUTI (odds ratio 9.35; P = 0.03).Conclusion Antibiotic prophylaxis significantly reduces the incidence of pyuria after URSL and tends to diminish the risk of bacteriuria and fUTI .