title: Is extended preoperative antibiotic prophylaxis for high-risk patients necessary before percutaneous nephrolithotomy?
abstract: The goal of this study was to compare the rate of systemic inflammatory response syndrome (SIRS) in high-risk patients undergoing percutaneous nephrolithotomy (PCNL) between patients who received 7, 2, or 0 days of preoperative antibiotics.
  
  
  
  We retrospectively reviewed a series of consecutive PCNLs performed at our institution. Patients with infected preoperative urine cultures were excluded. High-risk patients were defined as those with a history of previous urinary tract infection (UTI), hydronephrosis, or stone size ≥2 cm. Patients were treated with 7, 2, or 0 days of preoperative antibiotic prophylaxis prior to PCNL. All patients received a single preoperative dose of antibiotics within 60 minutes of the start of surgery. Fisher exact test was used to compare the rate of SIRS by preoperative antibiotic length.
  
  
  
  Of the 292 patients identified, 138 (47.3%) had sterile urine and met high-risk criteria, of which 27 (19.6%), 39 (28.3%), and 72 (52.2%) received 7, 2, and 0 days of preoperative antibiotics, respectively. The 3 groups were similar in age, sex, and duration of surgery (p>0.05). There was no difference in the rate of SIRS between the groups, with 1 of 27 (3.7%), 2 of 39 (5.1%) and 3 of 72 patients (4.2%) meeting criteria in the 7, 2, and 0 days antibiotic groups (p=~1).
  
  
  
  Extended preoperative antibiotic prophylaxis was not found to reduce the risk of SIRS after PCNL in our institutional experience of high-risk patients. For these patients, a single preoperative dose of antibiotics is sufficient.
authors.affiliation: Division of Urology, Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Potretzke
authors.affiliation: Division of Urology, Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: Alyssa M
authors.initials: AM
authors.lastname: Park
authors.affiliation: Division of Urology, Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: Tyler M
authors.initials: TM
authors.lastname: Bauman
authors.affiliation: Division of Urology, Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Larson
authors.affiliation: Division of Urology, Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Vetter
authors.affiliation: Urology Academic Practice, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Benway
authors.affiliation: Division of Urology, Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: Alana C
authors.initials: AC
authors.lastname: Desai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000074642:Nephrolithotomy, Percutaneous / Q000009:adverse effects* / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000517:prevention & control*; D019564:Unnecessary Procedures; D014552:Urinary Tract Infections / Q000209:etiology / Q000517:prevention & control; D052878:Urolithiasis / Q000473:pathology / Q000601:surgery*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic prophylaxis; Hydronephrosis; Percutaneous nephrostomy; Systemic inflammatory response syndrome; Urolithiasis