KYOTO, JAPAN (UroToday.com) -
Who needs a urine culture prior to SWL? Answer: EveryoneWho should have a urinalysis prior to SWL? Answer: Likely nobody
Who needs antibiotic prophylaxis prior to SWL? Answer: Hardly anyone.
In this provocative prospective study of 526 patients slated to undergo SWL, the authors noted that urine dipstick analysis picked up only 13% of the positive urine cultures (i.e. nitrite and leucocyte positive); hence the recommendation that prior to SWL all patients should have a urine culture and have directed antibiotic therapy if the culture is positive. On the other hand, among patients with a negative urine culture, regardless of the presence of an indwelling stent, preventative antibiotics should NOT be administered. Indeed, in this study only 1 patient (0.2%) who did not receive antibiotics developed a urinary tract infection.
One could make the case for deleting the urinalysis ($19 per test) and avoiding the use of prophylactic antibiotics ($18 for three tablets of Cipro in the United States), thereby reducing cost per SWL by $37/patient and also eliminating the side effects and selection of resistant bacteria from overuse of ciprofloxacin. A policy of this nature would have saved nearly $20,000 in this patient cohort.
Presented by Kirsten Foell at the 29th World Congress of Endourology & SWL (WCE) - November 30 - December 3, 2011 - Kyoto International Conference Center - Kyoto, Japan
Reported for UroToday by Ralph V. Clayman, MD, Chair, Department of Urology, University of California-Irvine Medical Center, Irvine, CA