Are Postoperative Antibiotics Necessary After Uncomplicated Ureteroscopy?
CUA Online Library. Alsabban A. 06/24/13; 31241; MP-02.05
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Abstract
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Introduction and Objectives:
The use of perioperative prophylactic antibiotics is intended to minimize infections resulting from surgical interventions. The AUA Recommendation is for antibiotic prophylaxis for <24 hours. This study sought to evaluate the rate of post-operative urinary infection following ureteroscopy.
Methods:
We retrospectively reviewed 153 subjects. Our initial chart review was for 73 subjects. All patients received pre-operative and not all patients received postoperative antibiotics. Post-operative urinary tract infection (UTI) was diagnosed only in 2 cases (3.6%). For this initial analysis we excluded patients who had history of recurrent cystitis or pyelonephritis, treatment for positive urine culture within 3 months of planned procedure, and indwelling nephrostomy tube or ureteral stent at the time of procedure. In order to substantiate our findings, we decided to collect more data without exclusions. Additional chart review was performed for 80 subjects who underwent ureteroscopy in Vancouver.
Results:
73/80 subjects (91.3%) were confirmed to have received pre-operative antibiotics (Cefazolin n=56), while 7 (8.8%) could not be verified. 41 (51.3%) subjects received post-operative antibiotics while 39 (48.8%) did not. Median age was 52.8+14.5 and mean BMI was 28.6+6.3. Laser lithrotripsy was used in 75 (93.8%), ureteral access sheath in 41 (51.3%), and a basket in 46 (57.5%). Even for the 80 additional subjects without exclusions, only four (5.0%) of the patients developed confirmed post-operative UTIs, two of whom received and the other two did not receive post-operative antibiotics.
Conclusions:
Our data suggests that post-operative antibiotics are not necessary as the rate of infection after ureteroscopic stone treatment is very low. There was no difference in postoperative infection rates and reducing antibiotic use will limit adverse effects such as drug-induced colitis and antibiotic resistance.
The use of perioperative prophylactic antibiotics is intended to minimize infections resulting from surgical interventions. The AUA Recommendation is for antibiotic prophylaxis for <24 hours. This study sought to evaluate the rate of post-operative urinary infection following ureteroscopy.
Methods:
We retrospectively reviewed 153 subjects. Our initial chart review was for 73 subjects. All patients received pre-operative and not all patients received postoperative antibiotics. Post-operative urinary tract infection (UTI) was diagnosed only in 2 cases (3.6%). For this initial analysis we excluded patients who had history of recurrent cystitis or pyelonephritis, treatment for positive urine culture within 3 months of planned procedure, and indwelling nephrostomy tube or ureteral stent at the time of procedure. In order to substantiate our findings, we decided to collect more data without exclusions. Additional chart review was performed for 80 subjects who underwent ureteroscopy in Vancouver.
Results:
73/80 subjects (91.3%) were confirmed to have received pre-operative antibiotics (Cefazolin n=56), while 7 (8.8%) could not be verified. 41 (51.3%) subjects received post-operative antibiotics while 39 (48.8%) did not. Median age was 52.8+14.5 and mean BMI was 28.6+6.3. Laser lithrotripsy was used in 75 (93.8%), ureteral access sheath in 41 (51.3%), and a basket in 46 (57.5%). Even for the 80 additional subjects without exclusions, only four (5.0%) of the patients developed confirmed post-operative UTIs, two of whom received and the other two did not receive post-operative antibiotics.
Conclusions:
Our data suggests that post-operative antibiotics are not necessary as the rate of infection after ureteroscopic stone treatment is very low. There was no difference in postoperative infection rates and reducing antibiotic use will limit adverse effects such as drug-induced colitis and antibiotic resistance.
Introduction and Objectives:
The use of perioperative prophylactic antibiotics is intended to minimize infections resulting from surgical interventions. The AUA Recommendation is for antibiotic prophylaxis for <24 hours. This study sought to evaluate the rate of post-operative urinary infection following ureteroscopy.
Methods:
We retrospectively reviewed 153 subjects. Our initial chart review was for 73 subjects. All patients received pre-operative and not all patients received postoperative antibiotics. Post-operative urinary tract infection (UTI) was diagnosed only in 2 cases (3.6%). For this initial analysis we excluded patients who had history of recurrent cystitis or pyelonephritis, treatment for positive urine culture within 3 months of planned procedure, and indwelling nephrostomy tube or ureteral stent at the time of procedure. In order to substantiate our findings, we decided to collect more data without exclusions. Additional chart review was performed for 80 subjects who underwent ureteroscopy in Vancouver.
Results:
73/80 subjects (91.3%) were confirmed to have received pre-operative antibiotics (Cefazolin n=56), while 7 (8.8%) could not be verified. 41 (51.3%) subjects received post-operative antibiotics while 39 (48.8%) did not. Median age was 52.8+14.5 and mean BMI was 28.6+6.3. Laser lithrotripsy was used in 75 (93.8%), ureteral access sheath in 41 (51.3%), and a basket in 46 (57.5%). Even for the 80 additional subjects without exclusions, only four (5.0%) of the patients developed confirmed post-operative UTIs, two of whom received and the other two did not receive post-operative antibiotics.
Conclusions:
Our data suggests that post-operative antibiotics are not necessary as the rate of infection after ureteroscopic stone treatment is very low. There was no difference in postoperative infection rates and reducing antibiotic use will limit adverse effects such as drug-induced colitis and antibiotic resistance.
The use of perioperative prophylactic antibiotics is intended to minimize infections resulting from surgical interventions. The AUA Recommendation is for antibiotic prophylaxis for <24 hours. This study sought to evaluate the rate of post-operative urinary infection following ureteroscopy.
Methods:
We retrospectively reviewed 153 subjects. Our initial chart review was for 73 subjects. All patients received pre-operative and not all patients received postoperative antibiotics. Post-operative urinary tract infection (UTI) was diagnosed only in 2 cases (3.6%). For this initial analysis we excluded patients who had history of recurrent cystitis or pyelonephritis, treatment for positive urine culture within 3 months of planned procedure, and indwelling nephrostomy tube or ureteral stent at the time of procedure. In order to substantiate our findings, we decided to collect more data without exclusions. Additional chart review was performed for 80 subjects who underwent ureteroscopy in Vancouver.
Results:
73/80 subjects (91.3%) were confirmed to have received pre-operative antibiotics (Cefazolin n=56), while 7 (8.8%) could not be verified. 41 (51.3%) subjects received post-operative antibiotics while 39 (48.8%) did not. Median age was 52.8+14.5 and mean BMI was 28.6+6.3. Laser lithrotripsy was used in 75 (93.8%), ureteral access sheath in 41 (51.3%), and a basket in 46 (57.5%). Even for the 80 additional subjects without exclusions, only four (5.0%) of the patients developed confirmed post-operative UTIs, two of whom received and the other two did not receive post-operative antibiotics.
Conclusions:
Our data suggests that post-operative antibiotics are not necessary as the rate of infection after ureteroscopic stone treatment is very low. There was no difference in postoperative infection rates and reducing antibiotic use will limit adverse effects such as drug-induced colitis and antibiotic resistance.
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