Compliance with American Urological Association Guidelines for Post-Percutaneous Nephrolithotomy Antibiotics Does Not Appear to Increase Rates of Infection.
OBJECTIVE
We compared infection rates after percutaneous nephrolithotomy in a group of patients without a history of infection or struvite calculi who received 24 hours or less of antibiotics postoperatively (ie compliance with AUA guidelines) vs a group that received 5 to 7 days of antibiotics postoperatively.


METHODS
We retrospectively reviewed the records of consecutive percutaneous nephrolithotomy procedures in patients without a history of urinary tract infection. Group 1 received 24 hours or less of antibiotics postoperatively and group 2 received a mean of 6 days of antibiotics postoperatively.


RESULTS
A total of 52 patients in group 1 (24 hours or less of antibiotics) and 30 in group 2 (mean 6 days of antibiotics) met study inclusion criteria. In 5 group 1 patients (9.6%) fever developed within 72 hours of percutaneous nephrolithotomy but none demonstrated bacteriuria or bacteremia on cultures. No patient in group 1 was treated for urinary tract infection on postoperative days 3 to 14. In 4 group 2 patients (13.3%) fever developed within 72 hours of percutaneous nephrolithotomy. A single patient showed bacteriuria (less than 10,000 cfu mixed gram-positive bacteria) on culture while no patient demonstrated bacteremia. No patient in group 2 was treated for urinary tract infection on postoperative days 3 to 14. There was no difference in stone-free rates or the need for additional procedures between the 2 groups.


CONCLUSIONS
In this pilot series compliance with AUA guidelines for antibiotic prophylaxis did not result in higher rates of infection than in a comparable group of 30 patients who received approximately 6 days of antibiotics postoperatively.
Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Urology, University of Vermont College of Medicine (KS), Burlington, Vermont.
Sameer
S
Deshmukh
Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Urology, University of Vermont College of Medicine (KS), Burlington, Vermont.
Kevan
K
Sternberg
Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Urology, University of Vermont College of Medicine (KS), Burlington, Vermont.
Natalia
N
Hernandez
Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Urology, University of Vermont College of Medicine (KS), Burlington, Vermont. Electronic address: beisner@partners.org.
Brian H
BH
Eisner
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D009403:Nephrostomy, Percutaneous; D011182:Postoperative Care / Q000592:standards*; D012189:Retrospective Studies; D012955:Societies, Medical; D014481:United States; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000517:prevention & control*; D014572:Urology
D000900:Anti-Bacterial Agents
anti-bacterial agents; compliance; kidney; nephrostomy; percutaneous; standards