Prospective Randomized Evaluation of Antimicrobial Prophylaxis in Patients Undergoing Extracorporeal Shock Wave Lithotripsy*

Abstract

Clear guidelines that address the appropriate use of prophylactic antibiotics in patients undergoing extracorporeal shock wave lithotripsy (ESWL) are not available. The purpose of this study was prospectively to evaluate the role of such antibiotics.Fifty-two patients with sterile urine (tested 3 days prior to ESWL or stent placement and not receiving antibiotics) were randomly assigned (double-blind) to receive oral placebo or norfloxacin 400 mg every 12 hours beginning 48 hours prior to ESWL, with the last dose at 6 am on the morning of the procedure. Urine cultures obtained on the first postoperative day were considered to be significant if the pure colony count exceeded 10,000/ml. No patients had perioperative sepsis. Although statistical evaluation showed no difference between the 24 évaluable norfloxacin-treated and the 25 évaluable placebo-treated patients in the frequency of urinary infection (p = 0.28), two of the patients in the placebo group, both of whom had other manipulations at the time of ESWL, had significant bacteriuria the day after treatment, and one of them was rehospitalized 4 days after ESWL for febrile urinary infection. In contrast, all patients in the norfloxacin group had sterile urine postoperatively. Although the data suggest that antimicrobial prophylaxis is not necessary in ESWL patients with sterile urine preoperatively, it is our impression that patients with a significant history of urinary infection who will have manipulations during ESWL may well benefit from prophylactic antibiotics. Further study on a larger cohort of patients will be necessary to corroborate this belief.

The Value of Antibiotic Prophylaxis during Extracorporeal ShockWave Lithotripsy in the Prevention of Urinary Tract Infections in Patients with Urine Proven Sterile prior to Treatment

“…Although we found no evidence of bacteria in the first urine specimen after ESWL in 174 patients, a large number of patients had bacteriuria either 2 or 6 weeks after ESWL, in both the placebo-and the antibiotictreated subjects. The incidence is much higher than reported by others [ 1,2,3,9,10] but in accordance to that found by Knipper et al [15], who reported that bacteria were found in 20% of the patients receiving antibiotic prophylaxis in cases of sterile urine before ESWL, in con trast to 16% of the patients receiving no antibiotic. A pos sible explanation for the high number of positive cultures is that the patients did not follow instructions to collect urine by clean-voided sampling.…”

“…In a series of 124 patients with negative urine cultures before treatment, Jonitz and Heinz [2] found a 16% incidence of bacterial contamination after ESWL. Although these data might suggest the need for antibiotic prophylaxis in ESWL treatment, Dejter et al [9] found no difference in frequency of urinary tract infections be tween antibiotic-treated and placebo-treated patients. Petterson and Tiselius [10] concluded that in the majority of patients with renal stones, prophylactic treatment with antibiotics is not necessary in the case of sterile urine, and Gattegno et al [ 11 ] also concluded that prophylactic anti biotic therapy does not appear to be necessary if the urine is sterile before ESWL.…”

“…Petterson and Tiselius [ 10] reported that despite the presence of a ureteric catheter in 30% of the patients, only 6.7% had bacteriuria after ESWL, and patients with ureteric stents did not present with more infections than those without. In a series of 52 patients, of whom 71 % under went placement of a catheter or stent in conjunction with ESWL, Dejter et al [9] found that multivariate logistic regression analysis with variables such as history of uri nary tract infection, indwelling double-J stent or manipu lation did not identify any of these factors to increase the risk of urinary infection following ESWL. Although in the present study the number of patients with a catheter or dilatation was relatively small we did not find any signifi cant difference in the incidence of bacteriuria between placebo-and antibiotic-treated patients.…”

CUA Guidelines on antibiotic prophylaxis for urologic procedures

“…Eight met the eligibility criteria for final inclusion in the systematic review. [8][9][10][11][12][13][14][15] Eight controlled trials randomized a total of 940 study participants ( Table 1). The incidence of UTI and fever were 4.2% and 3.4%, respectively.…”

Antibiotic Prophylaxis for Shock Wave Lithotripsy in Patients with Sterile Urine Before Treatment May be Unnecessary: A Systematic Review and Meta-Analysis

“…After referring to full texts, 9 publications (RCTs) involving 1,364 patients were included in the study. [13][14][15][16][17][18][19][20][21] Characteristics and quality of the included studies are presented in tables 1 and 2, and the search flow diagram is presented in figure 1. There were no significant differences in baseline information between the 2 groups.…”