CUA 2018: Duration of Antibiotic Therapy for Obstructive Infected Urinary Stones: An Analysis of Patients in a Tertiary Care Centre

Halifax, Nova Scotia ( The American Urological Association (AUA) and European guidelines recommend that infected urinary stone removal be undertaken only once the infection has been adequately treated, but the optimal duration of antibiotics in these cases is not defined. 

This was a retrospective observational study of patients admitted with obstructive infected kidney stone(s) at The Ottawa Hospital (TOH), Ontario, Canada. Patients 18 years of age or older, with a stent or a percutaneous nephrostomy tube and treated with either a 10 to 14-day course of antibiotics (+/- 2 days) followed by an antibiotic-free period until stone removal (group 1) or a longer continuous course of antibiotics until stone removal (+/- 2 days) (group 2) were included. The primary endpoint was recurrence of infection.

Study results suggest that a continuous course of antibiotics until definitive stone management may be beneficial in patients with an obstructive infected stone, or a subset thereof. Due to lack of power, the subgroup of patients, if any, that may benefit from a continuous course of antibiotics until stone removal could not be determined. This study provides an impetus to conduct a larger trial to confirm our findings, explore characteristics to identify which patients may benefit most from a continuous antibiotic course and/or test the hypothesis that the number of antibiotic-free days before definitive stone removal is a driving factor for recurrent infections.
Presented by Luke Witherspoon, MD, Department of Urology, University of Ottawa, Canada   
Co-Authors: Lizanne Béïque, Rosemary Zvonar, Kathryn Suh, Janet Squires, Matthew Roberts, Neal Rowe, James Watterson, Caroline Nott

Written by Luke Witherspoon and Zhamshid Okhunov, Twitter: @jwatterson8 and @OkhunovZhamDepartment of Urology, University of California-Irvine