title: Extended antimicrobial use in patients undergoing percutaneous nephrolithotomy and associated antibiotic related complications.
abstract: OBJECTIVE
  Despite global concern about antibiotic related complications the duration of antibiotic therapy at percutaneous nephrolithotomy varies based on individual physician practice. We evaluated perioperative antibiotic related complications in patients who received extended antimicrobial therapy at percutaneous nephrolithotomy.
  
  
  METHODS
  We reviewed the records of 227 consecutive patients treated with percutaneous nephrolithotomy from 2009 to 2013. Patients with positive urine or stone cultures received extended antimicrobial treatment. All others received 7 days of empirical therapy preoperatively and postoperatively. Adverse antibiotic related events were recorded for up to 3 months.
  
  
  RESULTS
  The median duration of antibiotic therapy was 14 days (IQR 14-34). Perioperatively 143 (63%), 67 (30%), 75 (33%) and 41 patients (18%) received nitrofurantoin, trimethoprim/sulfamethoxazole, fluoroquinolones and other antibiotics, respectively. Antibiotic related complications developed in 23 patients (10%) at a median of 12 days (IQR 8-19). Common complications included rash in 7 cases (3%), gastrointestinal upset in 6 (3%) and Clostridium difficile colitis in 1 (0.4%). Trimethoprim/sulfamethoxazole was associated with an increased likelihood of an adverse event (p = 0.04) but patient age, gender, and therapy type (therapeutic vs prophylactic) and duration were not. Finally, antibiotic and multidrug resistance developed in 4 (36%) and 3 patients (27%), respectively, who experienced a urinary tract infection.
  
  
  CONCLUSIONS
  We report a low rate of adverse antibiotic related events in patients treated with percutaneous nephrolithotomy who received extended perioperative antibiotic therapy. Exposure to trimethoprim/sulfamethoxazole was the only identifiable risk factor for a complication. These findings should be considered when counseling patients on the risks of perioperative antimicrobial therapy at percutaneous nephrolithotomy.
authors.affiliation: Department of Urology and Division of Biomedical Statistics and Informatics (EJB), Mayo Clinic, Rochester, Minnesota.
authors.forename: Boyd R
authors.initials: BR
authors.lastname: Viers
authors.affiliation: Department of Urology and Division of Biomedical Statistics and Informatics (EJB), Mayo Clinic, Rochester, Minnesota.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Cockerill
authors.affiliation: Department of Urology and Division of Biomedical Statistics and Informatics (EJB), Mayo Clinic, Rochester, Minnesota.
authors.forename: Ramila A
authors.initials: RA
authors.lastname: Mehta
authors.affiliation: Department of Urology and Division of Biomedical Statistics and Informatics (EJB), Mayo Clinic, Rochester, Minnesota.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Bergstralh
authors.affiliation: Department of Urology and Division of Biomedical Statistics and Informatics (EJB), Mayo Clinic, Rochester, Minnesota. Electronic address: Krambeck.amy@mayo.edu.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Krambeck
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D019072:Antibiotic Prophylaxis / Q000009:adverse effects*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D011183:Postoperative Complications / Q000139:chemically induced*; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotic prophylaxis; complications; kidney; nephrostomy; percutaneous; trimethoprim-sulfamethoxazole combination