Abstract
Introduction and Objectives: Urinary tract infections (UTI) following ureteroscopy (URS) occur in about 4% of patients. Due to the resistant bacterial strains we encounter in our institution, we retrospectively examined whether a double-drug antibiotic prophylactic treatment (APT) can reduce urosepsis after URS. Materials and Methods: Between February 2015 and March 2016, we performed 344 URS for stone treatment. Starting from September 2015, we changed the APT. Exclusion criteria included procedures involving percutaneous nephrolithotomy, pediatric or pregnant patients, and patients with preoperative clinical UTI. Results: Fifty-seven patients were excluded. Group 1 (n = 106) were the last to receive the conventional APT (oral ciprofloxacin), while the second group (n = 181) were the first to receive the new -regimen (intravenous gentamycin and ampicillin). A distinct percentage of both groups had a preoperative positive urine culture (29% in group 1 and 19% in group 2). Seven of 9 septic events developed in patients with preoperative positive urine culture (p < 0.001). Patients undergoing retrograde intrarenal surgery were at increased risk for sepsis when treated with conventional APT (p < 0.01). Post-URS sepsis was 7.5% using the conventional APT and 0.5% with the new APT (p < 0.0001). Conclusions: A distinct number of patients undergoing URS stone treatment have positive preoperative urine cultures. “One size fits all” APT is not sufficient according to our data. A regimen tailored to the local antibiotic resistance of the uropathogens can lower the rate of sepsis.
References
1.
Eswara
JR
, Shariftabrizi
A
, Sacco
D
. Positive stone culture is associated with a higher rate of sepsis after endourological procedures
. Urolithiasis
. 2013
Oct
;41
(5
):411
–4
.
[PubMed]
2194-72282.
Martov A1
, Gravas S, Etemadian M, Unsal A, Barusso G, D’Addessi A, Krambeck A de la RJCRO of the ESUSG. Postoperative infection rates in patients with a negative baseline urine culture undergoing ureteroscopic stone removal: a matched case-control analysis on antibiotic prophylaxis from the CROES URS global study. J Endourol. 29.3.
American Urological Association
. Best Practice Policy Statement on Urologic Surgery Antimicrobial Prophylaxis.
2013
;179
(April
):132
–340
.4.
Grabe
M
, Bartoletti
R
, Bjerklund-Johansen
TE
, Cai
T
, Çek
M
, Koves
B
, et al. Guidelines on Urological Infections.
Eur Assoc Urol [Internet]. 2015
;33–40. Available from: http://www.uroweb.org/gls/pdf/15_Urological_Infections.pdf5.
DasGupta
R
, Sullivan
R
, French
G
, O’Brien
T
. Evidence-based prescription of antibiotics in urology: a 5-year review of microbiology
. BJU Int
. 2009
Sep
;104
(6
):760
–4
.
[PubMed]
1464-40966.
Christiano
AP
, Hollowell
CM
, Kim
H
, Kim
J
, Patel
R
, Bales
GT
, et al. Double-blind randomized comparison of single-dose ciprofloxacin versus intravenous cefazolin in patients undergoing outpatient endourologic surgery
. Urology
. 2000
Feb
;55
(2
):182
–5
.
[PubMed]
0090-42957.
Levy
MM
, Fink
MP
, Marshall
JC
, Opal
SM
, Vincent
J
, Co-chair
GR
, et al. 2001 SCCM / ESICM / ACCP / ATS / SIS International Sepsis Definitions Conference. 2003
;530–8.8.
Gupta
K
, Hooton
TM
, Stamm
WE
. Increasing antimicrobial resistance and the management of uncomplicated community-acquired urinary tract infections
. Ann Intern Med
. 2001
Jul
;135
(1
):41
–50
.
[PubMed]
0003-48199.
Niranjan
V
, Malini
A
. Antimicrobial resistance pattern in Escherichia coli causing urinary tract infection among inpatients
. Indian J Med Res
. 2014
Jun
;139
(6
):945
–8
.
[PubMed]
0971-591610.
Karlowsky
JA
, Kelly
LJ
, Thornsberry
C
, Jones
ME
, Sahm
DF
. Trends in antimicrobial resistance among urinary tract infection isolates of Escherichia coli from female outpatients in the United States
. Antimicrob Agents Chemother
. 2002
Aug
;46
(8
):2540
–5
.
[PubMed]
0066-480411.
Gutierrez
J
, Smith
A
, Geavlete
P
, Shah
H
, Kural
AR
, de Sio
M
, et al.; CROES PCNL Study Group
. Urinary tract infections and post-operative fever in percutaneous nephrolithotomy
. World J Urol
. 2013
Oct
;31
(5
):1135
–40
.
[PubMed]
0724-498312.
Gonen
M
, Turan
H
, Ozturk
B
, Ozkardes
H
. Factors affecting fever following percutaneous nephrolithotomy: a prospective clinical study
. J Endourol
. 2008
Sep
;22
(9
):2135
–8
.
[PubMed]
0892-779013.
Lara-Isla
A
, Medina-Polo
J
, Alonso-Isa
M
, Benítez-Sala
R
, Sopeña-Sutil
R
, Justo-Quintas
J
, et al. Urinary infections in patients with catheters in the upper urinary tract: microbiological study
. Urol Int
. 2017
;98
(4
):442
–8
.
[PubMed]
0042-113814.
de la Rosette
J
, Denstedt
J
, Geavlete
P
, Keeley
F
, Matsuda
T
, Pearle
M
, et al.; CROES URS Study Group
. The clinical research office of the endourological society ureteroscopy global study: indications, complications, and outcomes in 11,885 patients
. [Internet]
. J Endourol
. 2014
Feb
;28
(2
):131
–9
. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24147820
[PubMed]
0892-779015.
Berardinelli
F
, De Francesco
P
, Marchioni
M
, Cera
N
, Proietti
S
, Hennessey
D
, et al. Infective complications after retrograde intrarenal surgery: a new standardized classification system
. Int Urol Nephrol
. 2016
Nov
;48
(11
):1757
–62
.
[PubMed]
0301-162316.
Ramaswamy
K
, Shah
O
. Antibiotic prophylaxis after uncomplicated ureteroscopic stone treatment: is there a difference?
[Internet]
. J Endourol
. 2012
Feb
;26
(2
):122
–5
. Available from: http://online.liebertpub.com/doi/abs/10.1089/end.2011.0360
[PubMed]
0892-779017.
Wollin
DA
, Joyce
AD
, Gupta
M
, Wong
MY
, Laguna
P
, Gravas
S
, et al. Antibiotic use and the prevention and management of infectious complications in stone disease
. World J Urol
. 2017
Sep
;35
(9
):1369
–79
.
[PubMed]
0724-498318.
Mariappan
P
. LOONG CW. Midstream urine culture and sensitivity test is a poor predictor of infected urine proximal to the obstructing ureteral stone or infected stones: a prospective clinical study. J Urol [Internet]. 2004
;171(6 Pt 1):2142–5. Available from: http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=15126773&retmode=ref&cmd=prlinks%5Cnfile:///Users/leezhao/Documents/Papers2/2004/Mariappan/J Urol 2004 MariappanMidstream urine culture and sensitivity test is a poor predictor of in19.
Korets
R
, Graversen
JA
, Kates
M
, Mues
AC
, Gupta
M
. Post-percutaneous nephrolithotomy systemic inflammatory response: a prospective analysis of preoperative urine, renal pelvic urine and stone cultures
. [Internet]
. J Urol
. 2011
Nov
;186
(5
):1899
–903
.
[PubMed]
0022-534720.
Lojanapiwat
B
, Kitirattrakarn
P
. Role of preoperative and intraoperative factors in mediating infection complication following percutaneous nephrolithotomy
. Urol Int
. 2011
;86
(4
):448
–52
.
[PubMed]
0042-113821.
Butler
CC
, Dunstan
F
, Heginbothom
M
, Mason
B
, Roberts
Z
, Hillier
S
, et al. Containing antibiotic resistance: decreased antibiotic-resistant coliform urinary tract infections with reduction in antibiotic prescribing by general practices
. Br J Gen Pract
. 2007
Oct
;57
(543
):785
–92
.
[PubMed]
0960-164322.
Khaw
C
, Oberle
AD
, Lund
BC
, Egge
J
, Heintz
BH
, Erickson
BA
, et al. Assessment of Guideline Discordance With Antimicrobial Prophylaxis Best Practices for Common Urologic Procedures
. JAMA Netw Open
. 2018
Dec
;1
(8
):e186248
.
[PubMed]
2574-3805© 2019 S. Karger AG, Basel
2019
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.
