title: Are prophylactic antibiotics necessary in patients with preoperative sterile urine undergoing ureterorenoscopic lithotripsy?
abstract: OBJECTIVE
  To compare the efficacy of prophylactic antibiotics in reducing post-surgical infections in patients undergoing ureterorenoscopic lithotripsy (URSL).
  
  
  METHODS
  The study was a double-blind, prospective, randomized controlled trial. Between 2009 and 2012, 212 patients with preoperative sterile urine undergoing URSL were randomly allocated, in a ratio of 1:1:1:1, to receive prophylactic antibiotics with single-dose i.v. cefazolin (1 g), ceftriaxone (1 g) or oral levofloxacin (500 mg), or no treatment (control group), respectively. Urine analysis and urine cultures were obtained between postoperative days 5 and 7. Pyuria was defined as ≥10 white blood cells/high power field. Significant bacteriuria was defined as ≥100,000 colony-forming units uropathogens/mL. Febrile urinary tract infection (fUTI) was defined as a body temperature of 38.5 °C with pyuria or significant bacteriuria ≤7 days after surgery.
  
  
  RESULTS
  In total, 206 patients were eligible for analysis. The rates of postoperative pyuria were significantly lower in patients with prophylaxis than in the control group (48.4 vs 64.7%, P = 0.04). Patients receiving prophylaxis with levofloxacin and ceftriaxone had a significantly lower risk of pyuria compared with the control group (52.0 and 36.5 vs 64.7%, respectively; P < 0.05). The rates of bacteriuria and fUTI tended to be lower in patients with prophylaxis, although the difference was not significant (4.5 vs 11.8%, P = 0.09, 1.3 vs 5.9%, P = 0.09). There was no significant difference in rates of bacteriuria and fUTI between the four groups. Patients with proximal stones had a higher risk of developing postoperative fUTI (odds ratio 9.35; P = 0.03).
  
  
  CONCLUSIONS
  Antibiotic prophylaxis significantly reduces the incidence of pyuria after URSL and tends to diminish the risk of bacteriuria and fUTI.
authors.affiliation: Division of Urology, Taipei Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, New Taipei, Taiwan; Medical College of Buddhist Tzu Chi University, Hualien, Taiwan.
authors.forename: Cheng-Hsing
authors.initials: CH
authors.lastname: Hsieh
authors.forename: Stephen Shei-Dei
authors.initials: SS
authors.lastname: Yang
authors.forename: Chia-Da
authors.initials: CD
authors.lastname: Lin
authors.forename: Shang-Jen
authors.initials: SJ
authors.lastname: Chang
mesh_terms: D000892:Anti-Infective Agents, Urinary / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001437:Bacteriuria / Q000382:microbiology; D002437:Cefazolin / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D005334:Fever / Q000517:prevention & control; D006801:Humans; D064704:Levofloxacin / Q000627:therapeutic use; D008096:Lithotripsy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000382:microbiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011300:Preoperative Care; D011446:Prospective Studies; D011776:Pyuria / Q000517:prevention & control; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000009:adverse effects / Q000379:methods; D014552:Urinary Tract Infections / Q000150:complications / Q000382:microbiology / Q000517:prevention & control*
chemical_list: D000892:Anti-Infective Agents, Urinary; D064704:Levofloxacin; D002443:Ceftriaxone; D002437:Cefazolin
keywords: antibiotics; infection; prophylaxis; stones; ureteroscopy