Can Perioperative Antibiotic Choice Impact Rates of Infectious Complications After Percutaneous Nephrolithotomy? A Single-Blind, Prospective Randomized Trial

Henry Collier Wright, Naveen Kachroo, Rajat Jain, Mohamed Omar, Donald Fedrigon, Dillon Corrigan, Anna Zampini, Smita De, Mark Noble, Wahib Isac, Manoj Monga, Sri Sivalingam

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: National guidelines recommend periprocedural antibiotics before percutaneous nephrolithotomy (PCNL), yet it is not clear which is superior. We conducted a randomized trial to compare two guideline-recommended antibiotics: ciprofloxacin (cipro) vs cefazolin, on PCNL outcomes, focusing on the development of systemic inflammatory response syndrome (SIRS) criteria. Methods: Adult patients who were not considered high risk for surgical or infectious complications and undergoing PCNL were randomized to receive either cipro or cefazolin perioperatively. All had negative preoperative urine cultures. Demographic and perioperative data were collected, including SIRS criteria, intraoperative urine culture, duration of hospitalization, and need for intensive care. SIRS is defined by ‡2 of the following: body temperature <96.8◦F or >100.4◦F, heart rate >90 bpm, respiratory rate >20 per minute, and white blood cell count <4000 or >12,000 cells/mm3. Results: One hundred forty-seven patients were enrolled and randomized (79 cefazolin and 68 cipro). All preoperative characteristics were similar (p > 0.05), except for mean age, which was higher in the cipro group (64 vs 57 years, p = 0.03). Intra- and postoperative findings were similar, with no difference between groups (p > 0.05), except a longer mean hospital stay in the cefazolin group (2 hours longer, p = 0.02). There was no difference between SIRS episodes in both univariate and multivariate analyses. Conclusions: Despite the relatively broader coverage for urinary tract pathogens with ciprofloxacin, this prospective randomized trial did not show superiority over cefazolin. Our findings therefore support two appropriate options for perioperative antibiotic prophylaxis in patients undergoing PCNL who are nonhigh risk for infectious complications.

Original languageEnglish
Pages (from-to)2-7
Number of pages6
JournalJournal of Endourology
Volume38
Issue number1
DOIs
StatePublished - 1 Jan 2024
Externally publishedYes

Keywords

  • PCNL
  • infection/inflammation
  • percutaneous nephrolithotomy
  • percutaneous renal surgery
  • renal stone
  • urolithiasis

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