Randomized comparison of effect of standard antibiotic prophylaxis versus enhanced prophylactic measures on rate of urinary tract infection after flexible ureteroscopy

Abstract

Purpose: To compare the rate of post-flexible ureteroscopy urinary tract infection (UTI) in patients subjected to the standard antibiotic prophylaxis alone versus enhanced prophylactic measures. Methods: A prospective randomized controlled study included 256 patients subjected to flexible ureteroscopy (FURS) for ureteral or renal stones from March 2018 to July 2022. Treatment groups included the standard antibiotic prophylaxis group (group 1, n=128) and the enhanced prophylaxis group (group 2, n=128). Patients in group 1 were injected with intravenous fluoroquinolone one hour preoperatively, and oral antibiotics were used for 24 h postoperatively. Patients in group 2 had urine culture ten days before the procedure; antibiotic-culture based was given for positive asymptomatic cases, while the procedure was deferred for active UTI. Results: The study groups were comparable regarding patient demographics, stone characteristics, operative time, and intraoperative complications. The overall hospitalization time was 1.68 ± 0.81 days. Postoperative, and overall complications were significantly higher in group 1 (15.6% vs. 6.3%, p = 0.04 and 26.6% vs. 17.2%, p = 0.047), respectively. Twenty patients (15.6 %) in the standard prophylaxis group were diagnosed with UTI in comparison to 8 patients (6.3 %) in the enhanced prophylaxis group (p = 0.047). Conclusions: Urinary tract infection after FURS could be reduced significantly by utilizing the suggested enhanced prophylactic approach.

Urinary Tract Infection Predictors in Patients Undergoing Retrograde IntraRenal Surgery for Renal Stones: Does the Instrument Make the Difference?

“…We reported a 22.3% rate of postoperative UTIs occurring in patients who underwent endoscopic procedure, which is consistent with rates in similar studies reported by Mitsuzuka et al (18.3%) [31] and by El-Agamy et al (15.6%) [29]. In the univariable logistic regression analysis, several factors associated with postoperative UTI, including stone diameter, number of stones, type of ureterorenoscope (multi-use vs. single-use), and operative time, were evaluated.…”

“…The interaction between urinary stones and bacterial colonization provides a fertile ground for the development of UTIs, as the presence of calculi can lead to urinary stasis, obstruction, and mucosal trauma, predisposing patients to microbial ascent and infection [27,28]. Recent studies in line with those reported from the EAU guidelines [17] offer valuable insights into the management of UTIs in urological practice, emphasizing the importance of risk stratification, perioperative antibiotic prophylaxis, and tailored antimicrobial therapy based on local resistance patterns and patient-specific factors [29,30].…”

Antibiotic prophylaxis in urologic interventions: Who, when, where?

“…40 Urine culture is not mentioned in European Guidelines. Its role in the prevention of UTIs has been analyzed by El-Agamy et al 79 A randomized comparison was performed between standard AP and enhanced prophylactic measures using urine cultures and targeted pharmacological therapy. Results demonstrated that an antibiotic-culture-based therapy could significantly reduce the risk of UTIs in patients undergoing ureteroscopy when compared with a traditional empirical antibiotic.…”

Surgical site infection prophylaxis: what have we learned and are we making progress?

“…Five studies were identified [26,49,50,51 ▪▪ ,52 ▪ ] of which only two had greater than 500 participants [51 ▪▪ ,52 ▪ ].…”

“…Five studies were identified [26,49,50 ]. The Urological Infections Guideline Group of the European Association of Urology (EAU) guidelines were recently updated [66] and highlight the preference for transperineal prostate biopsy (TPPB) over transrectal (TRPB) where possible due to lower infectious rates [66].…”