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WCE 2017: Prospective Randomized Trial of Antibiotic Prophylaxis Duration for Percutaneous Nephrolithotomy in Low-Risk Patients: Preliminary Results

Vancouver, Canada (UroToday.com) Dr. Patrick Samson, chief urology resident from the Smith Institute for Urology, presented data that compared the efficacy of two antibiotic courses for low infectious risk patients who underwent percutaneous nephrolithotomy (PCNL). As an introduction to his talk, Dr. Samson stated the American Urologic Association (AUA) recommended 24 hours or less of perioperative antibiotics following percutaneous renal surgery; however, the data to support this is limited to retrospective studies and a small prospective study. Their objective was to compare the infection and overall complication rates of the recommended 24-hour antibiotics protocol versus a short course protocol in which patients received antibiotics until their external catheters were removed.

Low infectious risk patients were defined as patients with sterile pre-operative urine cultures, no indwelling catheters and nephrostomy tubes, and no history of sepsis or immunosuppression. Of the 61 patients analyzed, 31 were randomized to the 24-hour protocol, and 30 were randomized to the short course protocol. Although the 24-hour arm was statistically younger (p=0.037), other baseline demographics, operative statistics, and stone size were similar between the two groups.

Dr. Samson and his team evaluated immediate and 30 day outcomes, and found there were no significant differences in infectious outcomes such as fevers (9.7% vs 10%, p=0.967) or incidence of systemic inflammatory response syndrome of bacteria (10.5% vs. 9.5%, p=0.393) between the two groups. Other outcomes such as length of stay and overall complication rates also had no significant differences.

In summary, they found a 24-hour protocol is not associated with an increased risk of infectious related complications in comparison to the short course protocol for low infectious risk patients who underwent PCNL. During discussion, it was suggested a new direction for this study could be to administer a course shorter and with less doses than the 24 hour protocol and compare the infection and overall complication rates to the AUA suggested 24 hour protocol.

Presented by: Patrick Samson, MD

Authors: Patrick Samson, Geoffery Gaunay, Samir Derisavifard, David Leavitt, Bradley Morganstern, Vinay Patel, Matthew Elmasri, Arthur Smith, David Hoenig, MD; Zeph Okeke, MD
Affiliation: Smith Institute for Urology, New Hyde Park, New York, Henry Ford Health System, Detroit, Michigan

Written by: Cyrus Lin, Department of Urology, University of California-Irvine at 35th World Congress of Endourology– September 12-16, 2017, Vancouver, Canada.