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Preoperative antibiotics offer no benefit in patients undergoing percutaneous nephrolithotomy

04 Oct 2018

A week of preoperative oral antibiotics prior to percutaneous nephrolithotomy does not appear to confer any benefit in patients at low risk for infectious complications, suggests a recent study. Perioperative antibiotics according to the American Urological Association (AUA) Best Practice Statement is deemed sufficient.

Eighty-six patients participated in the study. There were comparable preoperative patient characteristics in the treatment and control cohorts, with a stone size of 19 and 17 mm, respectively (p=0.47). No difference was seen in intraoperative characteristics.

The sepsis rate between the treatment and control groups was statistically comparable (12 percent and 14 percent, respectively; 95 percent CI, –0.163 to 0.122; p=1.0). Other infectious parameters and complications, such as intensive care admission, fever, hypotension and leukocytosis, were also similar between the two groups.

CONSORT (Consolidated Reporting of Trials) guidelines were used in this rigorous multi-institutional trial to evaluate preoperative antibiotics in patients undergoing percutaneous nephrolithotomy and at low risk for infection, defined as negative preoperative urine cultures and no urinary drain.

Of the participants, 43 were randomized to nitrofurantoin 100 mg twice daily for 7 days preoperatively, while 43 in the control arm received no oral antibiotics. Perioperative doses of ampicillin and gentamicin were given to all patients. Urologists blinded to randomization performed prone percutaneous nephrolithotomy. Sepsis development was the primary outcome.

“Single institution studies suggest a benefit of a week of preoperative antibiotics prior to percutaneous nephrolithotomy. These studies are limited by lower quality methodology, such as the inclusion of heterogeneous populations or nonstandard definitions of sepsis,” the investigators noted.

“The AUA Best Practice Statement recommends <24 hours of intravenous antibiotics, but to our knowledge no other data exist on the duration or benefit of preoperative antibiotics,” they added.

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