One week pre-operative oral antibiotics for percutaneous nephrolithotomy reduce risk of infection: a systematic review and meta-analysis

Abstract

Purpose The aim of this meta-analysis is to assess the efficacy of extended dose of preoperative antibiotics to reduce infectious risk in patients undergoing percutaneous nephrolithotomy (PCNL). Materials and Methods A literature search for prospective case-control studies or randomized controlled trials was done. PICO framework was used. Population: adult patients that underwent to PCNL; Intervention: extended dose preoperative antibiotic prophylaxis before PCNL; Control: short dose preoperative antibiotic prophylaxis before PCNL; and Outcome: systemic inflammatory response syndrome (SIRS) or sepsis, fever after PCNL and positive intraoperative urine and stone culture. This meta-analysis was registered in PROSPERO database under the number: CRD42022359589. Results Three RCT and two prospective studies (475 patients) were included. SIRS/sepsis outcome was retrieved from all studies included. Seven days preoperative oral antibiotics for PCNL was a protective factor for developing SIRS/sepsis (OR 0.366, 95% CI 0.234 - 0.527, p < 0.001). There was no statistical association between seven-day use of antibiotics and fever (OR 0.592, 95% CI 0.147 – 2.388, p = 0.462). Patients who received seven days preoperative antibiotics had lower positive intraoperative urine culture (OR 0.284, 95% CI 0.120 – 0.674, p = 0.004) and stone culture (OR 0.351, 95% CI 0.185 – 0.663, p = 0.001) than the control group. Conclusion one week of prophylactic oral antibiotics based on local bacterial sensitivity pattern plus a dose of intravenous antibiotics at the time of surgery in patients undergoing PCNL reduces the risk of infection.

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

“…In contrast, studies focusing exclusively on the preoperative scenario have indicated that seven days of oral antibiotics before PCNL can reduce the incidence of SIRS/sepsis, as well as the positivity of intraoperative urine culture and stone culture ( 26 ). It’s important to note that many, but not all, of the patients included in these studies had some infectious risk factors, such as larger stone size, positive preoperative urine culture, dilated pelvicalyceal system, or the presence of an indwelling ureteral stent or nephrostomy tube ( 26 ).…”

“…In contrast, studies focusing exclusively on the preoperative scenario have indicated that seven days of oral antibiotics before PCNL can reduce the incidence of SIRS/sepsis, as well as the positivity of intraoperative urine culture and stone culture ( 26 ). It’s important to note that many, but not all, of the patients included in these studies had some infectious risk factors, such as larger stone size, positive preoperative urine culture, dilated pelvicalyceal system, or the presence of an indwelling ureteral stent or nephrostomy tube ( 26 ). However, to the best of our knowledge, this is the first meta-analysis exclusively focusing on studies that compared patients receiving postoperative antibiotic prophylaxis until nephrostomy tube withdrawal with those receiving a single dose of antibiotic during the induction of anesthesia.…”

Nomogram to predict the risk of adverse outcomes in patients with residual stones following percutaneous nephrolithotomy

“…We collected the clinical data of all patients who underwent PCNL for upper urinary tract stones at First Affiliated Hospital of University of South China between January 1st, 2013, and May 31st, 2020. The inclusion criteria were as follows: ( 1 ) Patients who had residual stones after PCNL were included, ( 2 ) The postoperative residual stones were less than 7 mm in diameter. The exclusion criteria were as follows: ( 1 ) patients with incomplete clinical data; ( 2 ) patients lost to follow-up; ( 3 ) patients with malignant tumors; and ( 4 ) patients with obvious ureteral stenosis.…”

“…The inclusion criteria were as follows: ( 1 ) Patients who had residual stones after PCNL were included, ( 2 ) The postoperative residual stones were less than 7 mm in diameter. The exclusion criteria were as follows: ( 1 ) patients with incomplete clinical data; ( 2 ) patients lost to follow-up; ( 3 ) patients with malignant tumors; and ( 4 ) patients with obvious ureteral stenosis. A total of 233 cases were ultimately included according to the inclusion and exclusion criteria.…”

“…Percutaneous nephrolithotomy (PCNL) has been recommended as the primarily modality or gold standard for renal stones more than 2 cm, with a high success rate ( 1 , 2 ). Nevertheless, approximately 15%- 25% of patients with large stones are left with stone fragments after initial PCNL ( 3 ).…”