Introduction

The American Urologic Association (AUA) recommends 24 hours or less of perioperative antibiotics for percutaneous renal surgery; however, these are not based on randomized trials. Only recently have small, randomized studies been published to support the use of 24 hours of antibiotics in low risk patients undergoing percutaneous nephrolithotomy (PCNL). We aimed to compare the efficacy of a single-day versus short-course protocol of antibiotic prophylaxis for PCNL.

Methods

Low risk patients with a sterile pre-operative urine culture undergoing PCNL were randomized to either antibiotics for 24 hours (24H) or until external urinary catheters were removed (CR). Per AUA recommendations, patients were given a 1st generation cephalosporin, or ciprofloxacin in cases of penicillin allergy. Exclusion criteria included age <18 years, receiving antibiotics immediately prior to the procedure, history of sepsis from stone manipulation, presence of indwelling catheter >1 week, plan for multi-stage procedure, immunosuppression, pregnancy, multiple antibiotic allergies, and patients who are breastfeeding. Descriptive statistics and Fisher’s exact test were used to compare infection-related events and complication rates within 30 days of the procedure between groups.

Results

Since 2014, 41 patients have been randomized to either 24H (20) or CR (21). Mean duration of antibiotic administration was 25 hours and 45 hours in the 24H and CR groups, respectively. Demographics, comorbidities, and surgical parameters (including operative time) were similar between groups. Mean stone size was larger in the CR group (20 mm ± 5.86) compared to the 24H group (16 mm ± 5.23), p = 0.035. There have been no differences in febrile episodes or rates of systemic inflammatory response syndrome (SIRS). Only one patient (24H group) had evidence of bacteremia, while one patient in each arm had a urinary tract infection post-operatively. Overall complication rates were similar between the two groups (Table 1).

Conclusions

In the preliminary stages of our study, a 24-hour protocol for antibiotic prophylaxis does not increase the risk of infection-related events or overall complications compared to giving antibiotics until external catheters are removed in patients undergoing PCNL.

Funding

None