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    PCNL antibiotic regimens compared

    Routine administration of an extended preoperative course of antibiotics appears to be an unnecessary strategy for preventing urosepsis after percutaneous nephrolithotomy (PCNL) in high-risk patients with sterile urine, according to urologists from Washington University School of Medicine, St. Louis.

    The authors found no significant difference in proportion of patients meeting systemic inflammatory response syndrome (SIRS) criteria post-PCNL comparing groups treated with antibiotics for 7 days preoperatively, 2 days preoperatively, or with a single dose immediately before the procedure (3.7%, 5%, and 4.2%, respectively).

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    “Infection after PCNL can be a serious complication, and certain features have been identified that are associated with an increased risk of this event despite the presence of sterile urine prior to the procedure,” said co-author Aaron Potretzke, MD, an endourology fellow at Washington University.

    “Although previous studies have suggested that a 7-day course of preoperative antibiotic therapy is beneficial for reducing the risk of SIRS in high-risk patients with sterile urine, our findings indicate there is no reason to extend antibiotic treatment beyond a single perioperative dose,” added Dr. Potretzke, who worked on the study with Brian Benway, MD, and colleagues.

    The study, reported at the 2015 AUA annual meeting in New Orleans, looked retrospectively at 292 consecutive patients who had undergone PCNL between January 2012 and June 2014. All patients had urine samples obtained preoperatively, and only 139 patients who had both sterile urine and high-risk features (previous UTI, dilated pelvocaliceal systems, or stone size ≥20 mm) were included in the analysis to determine the rate of SIRS associated with different prophylactic regimens.

    There were 27 patients who received a 7-day course of antibiotics, 40 patients treated for 2 days preoperatively, and 72 patients who were given a single perioperative dose. Univariate analysis showed the three groups were similar with respect to gender, mean age, mean stone size, mean duration of surgery, and in their high-risk characteristics.

    Next: No significant differences among groups

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