Login to Access Video or Poster Abstract: MP75-10
Sources of Funding: None

Introduction

Post ureteroscopy UTI rate is about 4%. AUA guidelines suggest prophylaxis treatment for proximal or impacted stones. We examined whether a double drug Antibiotic Prophylaxis Treatment (APT), an aminoglycoside and penicillin based on resistant bacteria strains we encounter in our institution may reduce urosepsis post-ureteroscopy.

Methods

Between February 2015 and March 2016, we performed 344 ureteroscopies. Starting September, 2015 we changed the APT for endo-urological procedures according to the bacterial resistance profile in urine cultures at our institution. Inclusion criteria were adult patients referred to ureteroscopic treatment for a urinary stone, with or without prior stenting. Exclusion Criteria included integrated procedures (with PCNL), biopsies, pediatric or pregnant patients. Sepsis was defined as fever above 38.5 degrees Celsius with additional standard criteria (International Sepsis Definitions Conference). All patients had a urine culture taken prior to APT initiation. Fisher's exact test and T-test with a two-tailed P value < 0.05 denoted statistical significance.

Results

57 patients were excluded. Group 1 (n=106) were the last to receive the conventional APT (PO Ciprofloxacin 500mg X 2), while the second group (n=181) were the first to receive the new regimen (IV Gentamycin 240mg & Ampicillin 1gr X 3) prior to ureteroscopy. 65 patients had a preoperative positive culture. A significant percentage of both groups had a preoperative positive urine culture (29%-group 1; 18%-group 2). Seven out of 9 septic events developed in those patients (P<0.001). Patients undergoing RIRS procedures were at increased risk for a septic event when treated with conventional APT (7/9 events; P<0.01). No significant correlation was found between preoperative kidney drainage (stent or nephrostomy tube) and sepsis.

Conclusions

Our study demonstrates that a significant portion of patients undergoing ureteroscopic treatment for urinary stones have positive preoperative urine culture, despite previous treatment. Standard, 'one size fits all' APT is not sufficient according to our data. A regimen tailored to the local bacterial resistance strains can lower the rate of sepsis significantly.

Funding

None