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Introduction:We sought to investigate factors associated with unplanned 30 day readmission for genitourinary infection (URGUI) following ureteroscopy for laser lithotripsy (URSLL) including compliance with AUA guidelines (CAUAG) for antibiotic prophylaxis.
Materials & Methods: We performed a retrospective chart review evaluating all URSLL performed at a single academic institution from April 2011 to August 2014. Characteristics including demographics, comorbidities, surgical encounter characteristics (operative time, index length of stay, ureteral stent duration, staged procedure), preoperative urine culture, antibiotic type/duration, and CAUAG were extracted. Univariate and multivariate regression analysis were conducted to determine factors associated with URGUI.
Results:Among 531 patients undergoing URSLL, 248 (45%) were female with an average age of 56.8 (+/-14.8) yrs. Fifteen (2.8%) patients had URGUI. There was CAUAG in 268 (48.75%). Bivariate analysis revealed higher rates of URGUI with longer index length of stay (10.5% vs. 2.1%, p=0.002), operative time >120min (6.8% vs. 0.8%, p<0.001), and CAUAG (4.5% vs. 1.1% p120min (OR 11.9, CI: 2.2-64.6, p=0.004) and CAUAG (OR 4.64, CI: 1.08 to 19.9, p=0.039) were associated with increased risk of URGUI.
Conclusions:: Longer operative time and compliance with AUA guidelines for antibiotic prophylaxis were associated with higher risk of readmission for GU infection. Understanding of local resistance patterns and individualized prophylaxis strategies are imperative rather than uniform application of antibiotic guidelines. Additional study is needed to inform efforts to reduce GU infections after endoscopic stone surgery.