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BACKGROUND: The overuse of antibiotics is an important public health issue as it contributes to antibiotic resistance. The American Urological Association guildelines committee recommends ≤ 24 hours of antibiotics for percutaneous nephrolithotomy. The purpose of this study was to review the post-operative infectious complications in a series of patients for whom our practice was compliant with AUA guidelines.
METHODS: A retrospective review was performed of consecutive percutaneous nephrolithotomy procedures performed by a single surgeon. In our practice, patients without history of recurrent cystitis or struvite stones are treated according to AUA guidelines with antibiotics given when the patients enter the operating room and for less than 24 hours of total duration. All patients are seen within 14 days of their procedure for post-operative follow-up and incidence of infection was recorded. Inpatient and outpatient records were evaluated.
RESULTS: Fifty-two (52) patients met inclusion criteria. Five patients (9.6%) were treated with antibiotics for post-operative fever within 72 hours of PCNL. No patients (0%) were admitted to the intensive care unit for sepsis. No patients (0%) were treated for infection from post-operative days 3-14. Mean age was was 51.9 years and 29% of patients were female. The most common intra-operative antibiotics used were cefazolin (37%), ampicillin + gentamicin (19%), and ceftriaxone (17%). Mean operative time was 107.4 minutes (SD 32.0) and 34 accesses (65.0%) were below the 12^th rib. Stone size was > 2.0 cm in 79% of patients, and 23% of stones were staghorn calculi. Stone composition was pure or mixed calcium in 25 patients (46%), mixed calcium and uric acid in 10 patients (19%), pure uric acid in 3 (6%), struvite in 4 (8%), cystine in 2 (4%), and unknown in 8 (15%). Ureteral stent without nephrostomy was the drainage for 35% of procedures; the remainder had nephrostomy tube drainage for <48 hours.
CONCLUSIONS: In this pilot series of 54 patients in whom our practice complied with AUA guidelines for PCNL, 9.6% were treated for post-operative cystitis with antibiotics. There was no sepsis or delayed infection These results are encouraging and suggest that in properly selected patients, responsible use of antibiotics may not increase infectious complications. Further prospective and randomized studies would be helpful to confirm our findings.