Perioperative antibiotic prophylaxis for stone therapy

Schnabel, Marco J.; Wagenlehner, Florian M. E.; Schneidewind, Laila

doi:10.1097/mou.0000000000000576

Cited by 17 publications

(13 citation statements)

References 31 publications

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“…They aimed to tailor antibiotic prophylaxis with two agents based on their hospital's local resistance patterns, and found a decreased risk of septic events when compared with typical prophylaxis (27). Additionally, Schnabel et al came to a similar conclusion during their literature review of antibiotic prophylaxis in urolithiasis, with moderate benefit to single dose prophylaxis in patients undergoing RIRS (59). This would suggest that perioperative antibiotics be given based on local sensitivities if they are known.…”

Section: Intra-operative Considerationsmentioning

confidence: 96%

Prevention and Management of Infectious Complications of Retrograde Intrarenal Surgery

et al. 2021

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Kidney stone disease (KSD) is a commonly encountered ailment in urologic practice. Urinary tract infection (UTI) is commonly associated with KSD, both as an etiology (e.g., struvite and carbonate apatite stones), and as a complication (i.e., obstructive pyelonephritis and post-operative UTI). Indeed, a significant portion of the economic burden of KSD is skewed toward stones associated with infection. UTI is the most common post-operative complication related to stone intervention with progression to urosepsis as a rare but serious consequence. Risk for infection is influenced by a variety of factors including co-morbid conditions, anatomic abnormalities, prior surgical procedures, and local anti-microbial susceptibility. Understanding these risks and the proper steps to mitigate them is an essential component in reducing post-operative morbidity and mortality. Retrograde intrarenal surgery is routinely used for the treatment of KSD. The objective of this review article is to examine the current literature and guidelines for the prevention and management of stone-related infectious complications associated with retrograde intrarenal surgery. Special attention will be given to the incidence, etiology, and antibiotic prophylaxis choice in the management of stone-related infections. Intraoperative risk mitigation techniques will be discussed in conjunction with the management of post-operative infections. Antibiotic stewardship and the potential benefits of reduced empiric antibiotic treatment will also be discussed.

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Section: Intra-operative Considerationsmentioning

confidence: 96%

Prevention and Management of Infectious Complications of Retrograde Intrarenal Surgery

et al. 2021

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Section: Scenario #6 Stone Therapymentioning

confidence: 99%

“…Options for surgical removal of nephrolithiasis in patients with a normal urinary system include extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (UTS), and percutaneous nephrolithotomy (PCNL) [37,38]. Open or laparoscopic stone removal should be reserved for patients with anatomical abnormalities [37,38]. In adults, a recent analysis of published studies has shown that ESWL is associated with the development of UTIs and fever in 4.2% and 3.4% of cases and that SAP does not reduce either the risk of ppUTIs (relative risk [RR], 0.76; 95% CI, 0.39-1.48; p = 0.42) or the incidence of fever (RR, 0.26; 95% CI, 0.06-1.10; p = 0.07) [38].…”

Section: Scenario #6 Stone Therapymentioning

confidence: 99%

“…Open or laparoscopic stone removal should be reserved for patients with anatomical abnormalities [37,38]. In adults, a recent analysis of published studies has shown that ESWL is associated with the development of UTIs and fever in 4.2% and 3.4% of cases and that SAP does not reduce either the risk of ppUTIs (relative risk [RR], 0.76; 95% CI, 0.39-1.48; p = 0.42) or the incidence of fever (RR, 0.26; 95% CI, 0.06-1.10; p = 0.07) [38]. Consequently, preoperative SAP is not recommended apart from patients with a large stone burden, associated pyuria, history of pyelonephritis, and adjunctive operative procedures, as these subjects are considered at the highest risk of infectious complications.…”

Section: Scenario #6 Stone Therapymentioning

confidence: 99%

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Antimicrobial Prophylaxis for Urologic Procedures in Paediatric Patients: A RAND/UCLA Appropriateness Method Consensus Study in Italy

et al. 2022

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The main aim of surgical antimicrobial prophylaxis (SAP) in urologic procedures is to prevent bacteraemia, surgical site infections (SSIs), and postoperative urinary tract infections (ppUTIs). Guidelines for SAP in paediatric urology are lacking. Only some aspects of this complex topic have been studied, and the use of antibiotic prophylaxis prior to surgical procedures seems to be more often linked to institutional schools of thought or experts’ opinions than to rules dictated by studies demonstrating the most correct and preferred management. Therefore, the aim of this Consensus document realized using the RAND/UCLA appropriateness method is to provide clinicians with a series of recommendations on SAP for the prevention of bacteraemia, SSIs, and ppUTIs after urologic imaging and surgical procedures in paediatric patients. Despite the few available studies, experts agree on some basilar concepts related to SAP for urologic procedures in paediatric patients. Before any urological procedure is conducted, UTI must be excluded. Clean procedures do not require SAP, with the exception of prosthetic device implantation and groin and perineal incisions where the SSI risk may be increased. In contrast, SAP is needed in clean-contaminated procedures. Studies have also suggested the safety of eliminating SAP in paediatric hernia repair and orchiopexy. To limit the emergence of resistance, every effort to reduce and rationalize antibiotic consumption for SAP must be made. Increased use of antibiotic stewardship can be greatly effective in this regard.

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“…Most of the perioperative preventive administration routes are intravenous infusion, and only a few are oral administration. Intravenous infusion should be administered within 0.5 to 1 hour before the operation or at the beginning of anesthesia to ensure that the local tissues of the surgical site are exposed to antibacterial [5]. The drug has reached a drug concentration sufficient to kill the bacteria contaminated during the operation [6].…”

Section: Introductionmentioning

confidence: 99%

The Intervening Effect of Preventive Use of Antibacterials During the Perioperative Period in Orthopedic Department

Liu¹,

Qiu²,

Zhu³

et al. 2021

IJIDT

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Objective: To assess the effect of orthopedic perioperative antibiotic prophylaxis intervention by clinical pharmacist.Methods: 1467 hospitalized patients in department of orthopedics with perioperative records in eight months in 2019 were chosen. 597 surgical cases before intervention were sampled as the control group, and 870 surgical records were sampled as intervention group. Investigation and analysis were performed in orthopedic perioperative prophylactic antibiotics. Results: Compared with the control group, the intervention group showed increased rationalities and decreased irrationalities in perioperative antibiotic prophylaxis. The unreasonable external use of teicoplanin was significantly decreased, and the postoperative prophylaxis duration was significantly shortened. There were no significant difference in the timing of perioperative antibiotic prophylaxis between two groups. Conclusions: After interventions for the preventive use of antibacterial drugs in orthopedic perioperative period, the rational use of antibacterial drugs has been significantly improved, the irrational use of drugs has been improved, and the effect of drug treatment has been improved. However, there is still a gap between the rational use of antibacterial drugs. Further strengthen supervision and management.

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Perioperative antibiotic prophylaxis for stone therapy

Cited by 17 publications

References 31 publications

Prevention and Management of Infectious Complications of Retrograde Intrarenal Surgery

Prevention and Management of Infectious Complications of Retrograde Intrarenal Surgery

Antimicrobial Prophylaxis for Urologic Procedures in Paediatric Patients: A RAND/UCLA Appropriateness Method Consensus Study in Italy

The Intervening Effect of Preventive Use of Antibacterials During the Perioperative Period in Orthopedic Department

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