Ureteroscopy(URS) and percutaneous nephrolithotomy(PNL) are common procedures performed to treat kidney stones. Despite advances in technology/technique, serious infectious complications can occur. To better understand preoperative antibiotic administration patterns and adherence to guidelines from the American Urological Association(AUA) and the European Association of Urology(EAU), members of the Endourological Society were sent a clinical vignette-based survey to assess antibiotic use in a variety of pre-URS and pre-PNL scenarios.
Endourological Society members were emailed a survey that queried antibiotic therapy duration prior to uncomplicated URS and PNL with negative and asymptomatic positive preoperative urine cultures(PUCs). For negative PUC questions, selecting more than perioperative antibiotics was considered a "prolonged" course as it extends past the maximum of 24-hour perioperative prophylaxis recommended by both the AUA and EAU.
The response rate was 16.3% for a total of 326 responders. 21-39% of respondents report giving prolonged courses preoperative antibiotics before a URS or PNL with a negative PUC(p<0.0001). When presented with a negative PUC more prolonged antibiotic courses were reported with the following hierarchy: PNL for 2cm intrarenal stones(39%) >URS for 12mm renal pelvis stone(28%) >URS for 7mm distal ureteral stones(21%) (p<0.0001). In both negative and positive PUC questions, differences were noted in preoperative antibiotic prescribing patterns amongst site of practice(United States, Canada, Europe, Asia, South America and Other), type of practice (academic vs. all others), years in practice(< or ≥10 years), and surgical volume(URS and PNL > or ≤100 annual cases).
Adherence to guidelines on antibiotic administration prior to PNL and URS with a negative PUC varies by scenario and provider. In 21-39% of negative PUC cases, reported antibiotic use before a URS or PNL are not consistent with recommendations from the AUA and EAU. Before a positive PUC URS or PNL, nearly all surveyed provide preoperative antibiotics; however, the regimen length is variable.
Journal of endourology. 2018 Aug 16 [Epub ahead of print]
Evan Clayton Carlos, Ramy F Youssef, Adam Geoffrey Kaplan, Daniel Arthur Wollin, Brenton B Winship, Brian H Eisner, Roger L Sur, Glenn M Preminger, Michael Eric Lipkin
Duke University Medical Center, Urology, Durham, North Carolina, United States ; ., University of California, Irvine, Urology, Orange, California, United States ; ., St. Joseph Health Medical Group, Santa Rosa, California, United States ; ., Duke University Medical Center, Urology, Durham, North Carolina, United States ; ., Duke University Medical Center, Urology, Durham, North Carolina, United States ; ., Massachusetts General Hospital, Harvard Medical School, Urology, Boston, Massachusetts, United States ; ., University of California San Diego, 8784, Urology, San Diego, California, United States ; ., Duke University Medical Center, Urology , DUMC 3167 , Durham, North Carolina, United States , 27710 ; ., Duke University Medical Center, Surgery, Urology , DUMC 3167 , Durham, North Carolina, United States , 27710 ; .