A Randomized Controlled Trial of Preoperative Prophylactic Antibiotics for Percutaneous Nephrolithotomy in Moderate to High Infectious Risk Population: A Report from the EDGE Consortium

No AccessJournal of UrologyAdult Urology1 May 2021A Randomized Controlled Trial of Preoperative Prophylactic Antibiotics for Percutaneous Nephrolithotomy in Moderate to High Infectious Risk Population: A Report from the EDGE ConsortiumThis article is commented on by the following:Editorial Comment Roger L. Sur, Amy E. Krambeck, Tim Large, Seth K. Bechis, David F. Friedlander, Manoj Monga, Ryan S. Hsi, Nicole L. Miller, Ben H. Chew, Dirk Lange, Bodo Knudsen, Michael W. Sourial, Mitchell R. Humphreys, Karen L. Stern, Ojas Shah, Joel E. Abbott, and Garen Abedi Roger L. SurRoger L. Sur *Correspondence: E-mail Address: [email protected] UC San Diego Health, San Diego, California Financial interest and/or other relationship with Boston Scientific Corporation, Cook Medical, Karl Storz Endoscopy, Lumenis, Retrophin and Calyxo, Inc. More articles by this author , Amy E. KrambeckAmy E. Krambeck Methodist Hospital Indiana University, Indianapolis, Indiana Financial interest and/or other relationship with Boston Scientific Corporation and Sonomotion. More articles by this author , Tim LargeTim Large Methodist Hospital Indiana University, Indianapolis, Indiana More articles by this author , Seth K. BechisSeth K. Bechis UC San Diego Health, San Diego, California More articles by this author , David F. FriedlanderDavid F. Friedlander University of North Carolina School of Medicine, Chapel Hill, North Carolina More articles by this author , Manoj MongaManoj Monga UC San Diego Health, San Diego, California More articles by this author , Ryan S. HsiRyan S. Hsi Vanderbilt University Medical Center, Nashville, Tennessee More articles by this author , Nicole L. MillerNicole L. Miller Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with Boston Scientific Corporation, Virtuoso Surgical and Karl Storz Endoscopy. More articles by this author , Ben H. ChewBen H. Chew University of British Columbia, Vancouver, British Columbia, Canada More articles by this author , Dirk LangeDirk Lange Ohio State University, Columbus, Ohio Financial interest and/or other relationship with Boston Scientific Corporation, AdvaTech, Cook Medical and BD/Bard. More articles by this author , Bodo KnudsenBodo Knudsen Mayo Clinic, Scottsdale, Arizona More articles by this author , Michael W. SourialMichael W. Sourial Ohio State University, Columbus, Ohio More articles by this author , Mitchell R. HumphreysMitchell R. Humphreys Mayo Clinic, Scottsdale, Arizona More articles by this author , Karen L. SternKaren L. Stern Mayo Clinic, Scottsdale, Arizona More articles by this author , Ojas ShahOjas Shah Columbia University Irving Medical Center, New York, New York Financial interest and/or other relationship with Boston Scientific Corporation, Coloplast and Applaud Medical. More articles by this author , Joel E. AbbottJoel E. Abbott UC San Diego Health, San Diego, California Financial interest and/or other relationship with Boston Scientific Corporation and Karl Storz Endoscopy. More articles by this author , and Garen AbediGaren Abedi UC San Diego Health, San Diego, California More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001582AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Postoperative infectious related complications are not uncommon after percutaneous nephrolithotomy. Previously, we noted that 7 days of antibiotics did not decrease sepsis rates compared to just perioperative antibiotics in a low risk percutaneous nephrolithotomy population. This study aimed to compare the same regimens in individuals at moderate to high risk for sepsis undergoing percutaneous nephrolithotomy. Materials and Methods: Patients were prospectively randomized in this multi-institutional study to either 2 days or 7 days of preoperative antibiotics. Enrolled patients had stones requiring percutaneous nephrolithotomy and had either a positive preoperative urine culture or existing indwelling urinary drainage tube. Primary outcome was difference in sepsis rates between the groups. Secondary outcomes included rate of nonseptic bacteriuria, stone-free rate and length of stay. Results: A total of 123 patients at 7 institutions were analyzed. There was no difference in sepsis rates between groups on univariate analysis. Similarly, there were no differences in nonseptic bacteriuria, stone-free rate and length of stay. On multivariate analysis, 2 days of antibiotics increased the risk of sepsis compared to 7 days of antibiotics (OR 3.1, 95% CI 1.1–8.9, p=0.031). Patients receiving antibiotics for 2 days had higher rates of staghorn calculus than the 7-day group (58% vs 32%, p=0.006) but post hoc subanalysis did not demonstrate increased sepsis in the staghorn only group. Conclusions: Giving 7 days of preoperative antibiotics vs 2 days decreases the risk of sepsis in moderate to high risk percutaneous nephrolithotomy patients. Future guidelines should consider infectious risk stratification for percutaneous nephrolithotomy antibiotic recommendations. References 1. : The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients. J Endourol 2011; 25: 11. Google Scholar 2. : The role of antibiotic prophylaxis in percutaneous nephrolithotomy. Rev Urol 2016; 18: 10. Google Scholar 3. : Prevention and treatment of complications following percutaneous nephrolithotomy. Curr Opin Urol 2008; 18: 229. 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Google Scholar Registered under ClinicalTrials.gov ID NCT02829060. Supported by a grant from Boston Scientific Corporation. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByPerrella R, Vicentini F, Paro E, Torricelli F, Marchini G, Danilovic A, Batagello C, Mota P, Ferreira D, Cohen D, Murta C, Claro J, Giusti G, Monga M, Nahas W, Srougi M and Mazzucchi E (2021) Supine versus Prone Percutaneous Nephrolithotomy for Complex Stones: A Multicenter Randomized Controlled TrialJournal of Urology, VOL. 207, NO. 3, (647-656), Online publication date: 1-Mar-2022.Smith J (2021) This Month in Adult UrologyJournal of Urology, VOL. 205, NO. 5, (1247-1249), Online publication date: 1-May-2021.Related articlesJournal of UrologyMar 16, 2021, 12:00:00 AMEditorial Comment Volume 205Issue 5May 2021Page: 1379-1386Supplementary Materials Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.Keywordsnephrolithotomyanti-bacterial agentspercutaneousurolithiasisnephrolithiasissepsisMetricsAuthor Information Roger L. Sur UC San Diego Health, San Diego, California *Correspondence: E-mail Address: [email protected] Financial interest and/or other relationship with Boston Scientific Corporation, Cook Medical, Karl Storz Endoscopy, Lumenis, Retrophin and Calyxo, Inc. More articles by this author Amy E. Krambeck Methodist Hospital Indiana University, Indianapolis, Indiana Financial interest and/or other relationship with Boston Scientific Corporation and Sonomotion. More articles by this author Tim Large Methodist Hospital Indiana University, Indianapolis, Indiana More articles by this author Seth K. Bechis UC San Diego Health, San Diego, California More articles by this author David F. Friedlander University of North Carolina School of Medicine, Chapel Hill, North Carolina More articles by this author Manoj Monga UC San Diego Health, San Diego, California More articles by this author Ryan S. Hsi Vanderbilt University Medical Center, Nashville, Tennessee More articles by this author Nicole L. Miller Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with Boston Scientific Corporation, Virtuoso Surgical and Karl Storz Endoscopy. More articles by this author Ben H. Chew University of British Columbia, Vancouver, British Columbia, Canada More articles by this author Dirk Lange Ohio State University, Columbus, Ohio Financial interest and/or other relationship with Boston Scientific Corporation, AdvaTech, Cook Medical and BD/Bard. More articles by this author Bodo Knudsen Mayo Clinic, Scottsdale, Arizona More articles by this author Michael W. Sourial Ohio State University, Columbus, Ohio More articles by this author Mitchell R. Humphreys Mayo Clinic, Scottsdale, Arizona More articles by this author Karen L. Stern Mayo Clinic, Scottsdale, Arizona More articles by this author Ojas Shah Columbia University Irving Medical Center, New York, New York Financial interest and/or other relationship with Boston Scientific Corporation, Coloplast and Applaud Medical. More articles by this author Joel E. Abbott UC San Diego Health, San Diego, California Financial interest and/or other relationship with Boston Scientific Corporation and Karl Storz Endoscopy. More articles by this author Garen Abedi UC San Diego Health, San Diego, California More articles by this author Expand All Registered under ClinicalTrials.gov ID NCT02829060. Supported by a grant from Boston Scientific Corporation. Advertisement Loading ...