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Preoperative antibiotic therapy exceeding 7 days can minimize infectious complications after percutaneous nephrolithotomy in patients with positive urine culture

Abstract

Purpose

To explore an appropriate duration of antibiotic therapy before percutaneous nephrolithotomy (PCNL) in patients with positive urine culture.

Methods

From March 2016 to May 2018, consecutive patients with positive urine culture undergoing PCNL were prospectively registered. Initial preoperative antibiotics were given empirically. If needed, antibiotics were upgraded or adjusted to susceptible antibiotic after obtaining antibiotic-sensitivity test. Postoperative systemic inflammatory response syndrome (SIRS) was the primary outcome.

Results

Among the 220 participants, the incidence of positive stone culture and SIRS were 85.5% and 36.8%. Escherichia coli (53.6%, 44.5%) and Proteus mirabilis (8.2%, 10.0%) were the top two bacteria in urine and stones. In univariable analysis, patients with postoperative SIRS had a higher rate of stone culture positivity (97.5% VS 78.4%, P < 0.001) and a shorter duration of preoperative antibiotics therapy (3.4 ± 2.7 days versus 4.2 ± 2.8 days, P = 0.037). The landscape of SIRS showed a declining trend as the elongation of preoperative antibiotics (P = 0.039). In a day-by-day comparison, SIRS was less prevalent in patients treated by pre-PCNL antibiotics ≥ 7 days than in those with antibiotics ≤ 6 days (21.7% VS 40.8%, P = 0.017). Multivariable logistic regression confirmed positive stone culture (P = 0.001, OR 11.115) as an independent risk factor and pre-PCNL antibiotics ≥ 7 days (P = 0.048, OR 0.449) as an independent protective factor for SIRS. Preoperative antibiotic ≥ 7 days decreased SIRS from 45.4 to 27.8% and from 9.1 to 0% in patients with a positive and negative stone culture, respectively.

Conclusion

Exceeding seven days should be appropriate duration of antibiotic therapy before PCNL in patients with positive urine cultures.

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Abbreviations

PCNL:

Percutaneous nephrolithotomy

SIRS:

Systemic inflammatory response syndrome

EAU:

European Association of urology

UTIs:

Urinary tract infections

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Funding

This work was supported by the Guangdong Provincial Natural Science Project [2020A151501198], Key Project of Guangdong Provincial Department of Education [2018KZDXM056], and Guangzhou Medical University High-level Construction Project [201716007].

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WQW and GHZ and HJK: project development; X: data collection, statistical analysis, manuscript writing. TZ and DC and WZW: data collection; HFT and SJL: manuscript editing. All authors approved and contributed to the final manuscript.

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Correspondence to Wenqi Wu.

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Xu, P., Zhang, S., Zhang, Y. et al. Preoperative antibiotic therapy exceeding 7 days can minimize infectious complications after percutaneous nephrolithotomy in patients with positive urine culture. World J Urol (2021). https://doi.org/10.1007/s00345-021-03834-y

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Keywords

  • Appropriate duration
  • Preoperative antibiotic therapy
  • Percutaneous nephrolithotomy
  • Positive urine culture
  • Systemic inflammatory response syndrome