TAIPEI, TAIWAN (UroToday.com) - Introduction and Objectives: To determine variations in antimicrobial use prior to endourological surgery for urolithiasis and to correlate these variations to site, pattern and volume of clinical practice.
Methods: An online survey was distributed by e-mail to members of the Endourologic Society. The survey queried the duration of antimicrobial therapy prior to uncomplicated ureteroscopy (URS) and percutaneous nephrolithotomy (PNL) with negative and asymptomatic positive pre-operative urine cultures.
Results: The response rate was 18.5% with 369 responders (40% from U.S., 61% academic and 64% endourology fellowship trained). The majority of respondents reported giving a single perioperative dose in patients with a negative urine culture (71% and 59% prior to URS and PNL; respectively). In patients with positive cultures, there were more heterogeneous responses. In presence of positive culture prior to URS: 13% preferred single perioperative dose, 29% preferred 1–3 days, 46% preferred 4–7 days and 12% preferred > 7 days of antibiotics before the procedure. In presence of positive culture prior to PNL: 11% preferred single perioperative dose, 24% preferred 1–3 days, 49% preferred 4–7 days and 16 % preferred > 7 days. There were significant variations in antimicrobial utilization prior to endourological management by geographical location of practice (p < 0.05).
Conclusions: There are considerable variations in antimicrobial utilization prior to endourological surgery for urolithiasis worldwide. According to current guidelines, almost 1/3 of urologists are over-utilizing antibiotics prior to stone management in patients with negative cultures. Well-designed prospective randomized studies are needed to guide appropriate duration of antibiotics in patients with positive cultures before these procedures.
Source of Funding: None
|View an interview with Adam Kaplan, one of the authors of this study.|
Presented by Ramy Youssef,1, 4 Richard Shin,1 Fernando Cabrera1, Adam Kaplan,1, 4 Andreas Neisius,5 Charles Scales,1, 6 Roger Sur,3 Anika Ackerman,1 Michael Ferrandino,1 Brien Eisner,2 Glenn Preminger,1 and Michael Lipkin1 at the 32nd World Congress of Endourology & SWL - September 3 - 7, 2014 - Taipei, Taiwan
1Duke University Medical Center, USA
2Massachusetts General Hospital, Harvard Medical School, USA
3UC San Diego Health System, USA
4University of California, Irvine, USA
5Universitatsmedizin Mainz, Germany
6Duke Clinical Research Institute, USA