Infectious Outcomes from Renal Tumor Ablation: Prophylactic Antibiotics or Not?

Variability exists among institutions and physicians regarding the use of prophylactic antibiotics for ablation of renal tumors. The literature was reviewed for infectious complications vis-à-vis the reported use of prophylactic antibiotics for tumor ablation of renal neoplasms.

PubMed was searched for articles reporting radiofrequency ablation, cryoablation, and microwave ablation of renal masses, both by percutaneous and laparoscopic approaches. Data regarding potentially infectious outcomes, prophylactic antibiotic use or not, patient information, lesion characteristics, and procedural specifics were extracted from relevant articles.

Fifty-one articles met the inclusion criteria. Potentially infectious complications occurred in 74/6952 patients (1.06%) if fever is included, but only 29 patients (0.42%) if fever is excluded. Prophylactic antibiotics were reported in 373 patients and were not mentioned in 6579 patients. The incidence of fever was higher with the laparoscopic radiofrequency ablation and cryoablation compared to the percutaneous approach (p < 0.001).

Prophylactic antibiotics seldom are used and/or reported in renal tumor ablation, and when they are, the antibiotic regimens vary widely. Even so, infectious complications in renal tumor ablation are uncommon. The similar and very low rates of infectious outcomes among ablation types and the two access approaches (laparoscopic and percutaneous) suggest that prophylactic antibiotics for routine renal tumor ablation are unnecessary.

Cardiovascular and interventional radiology. 2018 Jul 30 [Epub ahead of print]

Daniel Crawford, Eric vanSonnenberg, Paul Kang

The University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA., The University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA. .