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
References
C. Türk, A. Neisius, A. Petřík, C. Seitz, A. Skolarikos (Vice-chair), B. Somani, K. Thomas, G. Gambaro. European association of urology (EAU) guidelines on urolithiasis 2021. ISBN 978-94-92671-13-4. Available at https://uroweb.org/guideline/urolithiasis/. Accessed June 2021.
G. Bonkat, R. Bartoletti, F. Bruyère, T. Cai, S.E. Geerlings, B. Köves, S. Schubert, F. Wagenlehner. European association of urology (EAU) guidelines on urological infections 2021, ISBN 978-94-92671-13-4. Available at https://uroweb.org/guideline/urological-infections/ Accessed June 2021.
Liu J, Zhou C, Gao W, Huang H, Jiang X, Zhang D (2020) Does preoperative urine culture still play a role in predicting post-PCNL SIRS? A retrospective cohort study. Urolithiasis 48(3):251–256. https://doi.org/10.1007/s00240-019-01148-8
Gorgotsky I, Shkarupa D, Shkarupa A, Yarova N, Suchkov D (2020) A feasibility of percutaneous nephrolithotomy in positive urine culture: a single center retrospective study. Urol J. https://doi.org/10.22037/uj.v0i0.5561
Sur RL, Krambeck AE, Large T et al (2021) A randomized controlled trial of preoperative prophylactic antibiotics for percutaneous nephrolithotomy in moderate to high infectious risk population: a report from the EDGE consortium. J Urol 205(5):1379–1386. https://doi.org/10.1097/JU.0000000000001582
Viers BR, Cockerill PA, Mehta RA, Bergstralh EJ (2014) Extended antimicrobial use in patients undergoing percutaneous nephrolithotomy and associated antibiotic related complications. J Urol 192(6):1667–1672. https://doi.org/10.1016/j.juro.2014.06.090
Gupta K, O’Brien W, Gallegos-Salazar J, Strymish J, Branch-Elliman W (2020) How testing drives treatment in asymptomatic patients: level of pyuria directly predicts probability of antimicrobial prescribing. Clin Infect Dis 71(3):614–621. https://doi.org/10.1093/cid/ciz861
Jiang J, Yang J, Mei J, Jin Y, Lu Y (2018) Head-to-head comparison of qSOFA and SIRS criteria in predicting the mortality of infected patients in the emergency department: a meta-analysis. Scand J Trauma Resusc Emerg Med 26:56. https://doi.org/10.1186/s13049-018-0527-9
Xu P, Zhang S, Zhang Y et al (2021) Enhanced antibiotic treatment based on positive urine dipstick infection test before percutaneous nephrolithotomy did not prevent postoperative infection in patients with negative urine culture. J Endourol. https://doi.org/10.1089/end.2021.0185
Mariappan P, Smith G, Moussa SA, Tolley DA (2006) One week of ciprofloxacin before percutaneous nephrolithotomy significantly reduces upper tract infection and urosepsis: a prospective controlled study. BJU Int 98(5):1075–9. https://doi.org/10.1111/j.1464-410X.2006.06450.x
Bag S, Kumar S, Taneja N, Sharma V, Mandal AK, Singh SK (2011) One week of nitrofurantoin before percutaneous nephrolithotomy significantly reduces upper tract infection and urosepsis: a prospective controlled study. Urology 77(1):45–49. https://doi.org/10.1016/j.urology.2010.03.025
Paonessa JE, Gnessin E, Bhojani N, Williams JC, Lingeman JE (2016) Preoperative bladder urine culture as a predictor of intraoperative stone culture results: clinical implications and relationship to stone composition. J Urol 196(3):769–774. https://doi.org/10.1016/j.juro.2016.03.148
Walton-Diaz A, Vinay JI, Barahona J et al (2017) Concordance of renal stone culture: PMUC, RPUC, RSC and post-PCNL sepsis-a non-randomized prospective observation cohort study. Int Urol Nephrol 49(1):31–35. https://doi.org/10.1007/s11255-016-1457-y
Zeng Tao, Chen Dong, Weizhou Wu et al (2020) Optimal perioperative antibiotic strategy for kidney stone patients treated with percutaneous nephrolithotomy. Int J Infect Dis 97:162–166. https://doi.org/10.1016/j.ijid.2020.05.095
Chen D, Jiang C, Liang X et al (2019) Early and rapid prediction of postoperative infections following percutaneous nephrolithotomy in patients with complex kidney stones. BJU Int 123(6):1041–1047. https://doi.org/10.1111/bju.14484
Mariappan P, Smith G, Bariol SV, Moussa SA, Tolley DA (2005) Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy: a prospective clinical study. J Urol 173(5):1610–1614. https://doi.org/10.1097/01.ju.0000154350.78826.96
Margel D, Ehrlich Y, Brown N, Lask D, Livne PM, Lifshitz DA (2006) Clinical implication of routine stone culture in percutaneous nephrolithotomy—a prospective study. Urology 67(1):26–29. https://doi.org/10.1016/j.urology.2005.08.008
Roushani A, Falahatkar S, Sharifi SH et al (2014) Intra-operative stone culture as an independent predictor of systemic inflammatory response syndrome after percutaneous nephrolithotomy. Urolithiasis 42(5):455–459. https://doi.org/10.1007/s00240-014-0688-6
Chew BH, Miller NL, Abbott JE et al (2018) A randomized controlled trial of preoperative prophylactic antibiotics prior to percutaneous nephrolithotomy in a low infectious risk population: a report from the EDGE consortium. J Urol 200(4):801–808. https://doi.org/10.1016/j.juro.2018.04.062
Potretzke AM, Park AM, Bauman TM et al (2016) Is extended preoperative antibiotic prophylaxis for high-risk patients necessary before percutaneous nephrolithotomy? Investig Clin Urol 57(6):417–423. https://doi.org/10.4111/icu.2016.57.6.417
Li X, Lu N, Brady H, Packman A (2016) Ureolytic biomineralization reduces proteus mirabilis biofilm susceptibility to ciprofloxacin. Antimicrob Agents Chemother 60(5):2993–3000. https://doi.org/10.1128/AAC.00203-16
Zhao F, Yang H, Bi D, Khaledi A, Qiao M (2020) A systematic review and meta-analysis of antibiotic resistance patterns, and the correlation between biofilm formation with virulence factors in uropathogenic E. coli isolated from urinary tract infections. Microb Pathog 144:104196. https://doi.org/10.1016/j.micpath.2020.104196
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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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 40, 193–199 (2022). https://doi.org/10.1007/s00345-021-03834-y
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DOI: https://doi.org/10.1007/s00345-021-03834-y