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Meta-Analysis
. 2024 Mar-Apr;50(2):152-163.
doi: 10.1590/S1677-5538.IBJU.2023.0626.

Postoperative antibiotic prophylaxis for percutaneous nephrolithotomy and risk of infection: a systematic review and meta-analysis

Thalita Bento Talizin  1 , Alexandre Danilovic  1   2 , Fabio Cesar Miranda Torricelli  3 , Giovanni S Marchini  3 , Carlos Batagello  1 , Fabio C Vicentini  3 , William Carlos Nahas  4 , Eduardo Mazzucchi  3
Affiliations
Meta-Analysis

Postoperative antibiotic prophylaxis for percutaneous nephrolithotomy and risk of infection: a systematic review and meta-analysis

Thalita Bento Talizin et al. Int Braz J Urol. 2024 Mar-Apr.

Abstract

Purpose: The aim of this study is to perform a high-quality meta-analysis using only randomized controlled trials (RCT) to better define the role of postoperative antibiotics in patients undergoing percutaneous nephrolithotomy (PCNL).

Materials and methods: A literature search for RCTs in EMBASE, PubMed, and Web of Science up to May 2023 was conducted following the PICO framework: Population-adult patients who underwent PCNL; Intervention-postoperative antibiotic prophylaxis until nephrostomy tube withdrawal; Control-single dose of antibiotic during the induction of anesthesia; and Outcome-systemic inflammatory response syndrome (SIRS) or sepsis and fever after PCNL. The protocol was registered on the PROSPERO database (CRD42022361579). We calculated odds ratios (OR) and 95% confidence intervals (CI). A random-effects model was employed, and the alpha risk was defined as < 0.05.

Results: Seven articles, encompassing a total of 629 patients, were included in the analysis. The outcome of SIRS or sepsis was extracted from six of the included studies, while the outcome of postoperative fever was extracted from four studies. The analysis revealed no statistical association between the use of postoperative antibiotic prophylaxis until nephrostomy tube withdrawal and the occurrence of SIRS/sepsis (OR 1.236, 95% CI 0.731 - 2.089, p=0.429) or fever (OR 2.049, 95% CI 0.790 - 5.316, p=0.140).

Conclusion: Our findings suggest that there is no benefit associated with the use of postoperative antibiotic prophylaxis until nephrostomy tube withdrawal in patients undergoing percutaneous nephrolithotomy (PCNL). We recommend that antibiotic prophylaxis should be administered only until the induction of anesthesia in PCNL.

Keywords: Diagnosis; Prostatic Neoplasms; Robotic Surgical Procedures.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1. PRISMA flowchart.
Figure 2
Figure 2. Risk of bias of randomized controlled trials.
Figure 3
Figure 3. Funnel plot – (A) RCTs included in the meta-analysis for the risk of SIRS or sepsis; (B) RCTs included in the meta-analysis for the risk of fever.
Figure 4
Figure 4. Forest plot – (A) SIRS or sepsis in control vs. intervention; (B) fever in control vs. intervention.
See this image and copyright information in PMC

References

    1. Geraghty RM, Davis NF, Tzelves L, Lombardo R, Yuan C, Thomas K, et al. Best Practice in Interventional Management of Urolithiasis: An Update from the European Association of Urology Guidelines Panel for Urolithiasis 2022. Eur Urol Focus. 2023;9:199–208. - PubMed
    1. Gutierrez J, Smith A, Geavlete P, Shah H, Kural AR, de Sio M, et al. Urinary tract infections and post-operative fever in percutaneous nephrolithotomy. World J Urol. 2013;31:1135–1140. - PMC - PubMed
    1. Zhou G, Zhou Y, Chen R, Wang D, Zhou S, Zhong J, et al. The influencing factors of infectious complications after percutaneous nephrolithotomy: a systematic review and meta-analysis. Urolithiasis. 2022;51:17–17. - PMC - PubMed
    1. Korets R, Graversen JA, Kates M, Mues AC, Gupta M. Post-percutaneous nephrolithotomy systemic inflammatory response: a prospective analysis of preoperative urine, renal pelvic urine and stone cultures. J Urol. 2011;186:1899–1903. - PubMed
    1. Mishra A, Mittal J, Tripathi S, Paul S. Factors predicting infective complications following percutaneous nephrolithotomy and retrograde intrarenal surgery according to systemic inflammatory response syndrome and quick sequential organ failure assessment: A prospective study. Urol Ann. 2023;15:295–303. - PMC - PubMed

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