Fever after shockwave lithotripsy--risk factors and indications for prophylactic antimicrobial treatment.
OBJECTIVE
To identify risk factors for fever after shockwave lithotripsy (SWL) and suggest guidelines for prophylactic antimicrobial treatment.


METHODS
Between 1985 and 2007, a total of 15,324 SWL procedures were performed in our institution using the Dornier HM3 lithotripter. Because stone analyses were not available in the majority of patients, management of stones larger than 2 cm in diameter were excluded from this analysis to minimize the ratio of struvite stones as a possible cause for postprocedural fever. In this analysis, 11,500 SWL treatments were included. Clinical parameters before, during, and after treatments were prospectively registered using a computerized database. Potential risk factors for fever after SWL were evaluated.


RESULTS
Fever >38.0 degrees C developed in 161 (1.4%) patients. The risk factors for fever after SWL were: A positive urine culture (P < 0.05), an indwelling nephrostomy tube or stent during the procedure (P < 0.001), lithotripsy of kidney or upper ureteral stones (P < 0.05) and preoperative symptomatic urinary tract infection (UTI) (P < 0.05) or sepsis (P < 0.05). Lithotripsy of mid and lower ureteral stones, stone size, and the use of ureteral catheters during the procedures were not associated with increased risk of fever after SWL.


CONCLUSIONS
Fever (>38.0 degrees C) develops in only 1.4% of the patients undergoing SWL. Therefore, prophylactic antibiotic treatment is not indicated in all patients. Selective prophylactic treatment is recommended in patients who present with UTI, kidney or upper ureteral stones, and those for whom a nephrostomy tube or stent is necessary.
Duvdevani
Mordechai
M
Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel. moti_duv@yahoo.com
Lorber
Gideon
G
Gofrit
Ofer N
ON
Latke
Arie
A
Katz
Ran
R
Landau
Ezekiel H
EH
Meretyk
Shimon
S
Shapiro
Amos
A
Pode
Dov
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000209:etiology* / Q000652:urine; D006801:Humans; D007223:Infant; D008096:Lithotripsy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014556:Urine / Q000382:microbiology; D055815:Young Adult
D000890:Anti-Infective Agents