title: Fever after shockwave lithotripsy--risk factors and indications for prophylactic antimicrobial treatment.
abstract: 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.
authors.affiliation: Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel. moti_duv@yahoo.com
authors.forename: Mordechai
authors.initials: M
authors.lastname: Duvdevani
authors.forename: Gideon
authors.initials: G
authors.lastname: Lorber
authors.forename: Ofer N
authors.initials: ON
authors.lastname: Gofrit
authors.forename: Arie
authors.initials: A
authors.lastname: Latke
authors.forename: Ran
authors.initials: R
authors.lastname: Katz
authors.forename: Ezekiel H
authors.initials: EH
authors.lastname: Landau
authors.forename: Shimon
authors.initials: S
authors.lastname: Meretyk
authors.forename: Amos
authors.initials: A
authors.lastname: Shapiro
authors.forename: Dov
authors.initials: D
authors.lastname: Pode
mesh_terms: 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
chemical_list: D000890:Anti-Infective Agents