Antibiotic prophylaxis after uncomplicated ureteroscopic stone treatment: is there a difference?

Abstract

Purpose: We evaluated the risk of development of a symptomatic urinary tract infection (UTI) based on the antibiotic prophylaxis given to a patient during and after uncomplicated ureteroscopy (URS) for urolithiasis.

Patients and methods: We retrospectively reviewed the charts of patients who underwent URS, laser lithotripsy, and stent placement for the management of stones from 2004/2005 (group 1) and 2009/2010 (group 2). We excluded all patients with preoperative positive cultures, preoperative antibiotics, urinary diversion, who underwent concomitant percutaneous nephrolithotomy, or had strings attached to the stents. All patients received a first-generation intravenous cephalosporin or fluoroquinolone at the time of initial intervention and had ureteral stents placed intraoperatively. Group 1 received an oral fluoroquinolone for 1 week postoperatively. Group 2 received an oral first-generation cephalosporin antibiotic peri-stent removal only. Antibiotics were appropriately changed according to the local resistance patterns. All stents were removed within 5 to 7 days. Our primary end point was symptomatic UTI.

Results: After the exclusion criteria, group 1 had 48 patients, group 2 had 49. There was no statistical difference in the incidence of symptomatic UTI between the two groups; each group had one UTI (2% risk) (P=0.988). There were no cases of readmission, pyelonephritis, UTI, surgical reintervention, or Clostridium difficile. The UTI in group 1 was secondary to Escherichia coli and in group 2, Staphylococcus species; both were managed with oral antibiotics.

Conclusions: The use of oral peri-stent removal antibiotic prophylaxis is sufficient to prevent symptomatic UTIs in patients who have undergone uncomplicated URS for urolithiasis. The judicious use of antibiotics in uncomplicated cases may help lower the incidence of resistant organisms and other complications related to the widespread use of antibiotics.