Recommended antibiotic prophylaxis regimen in retrograde intrarenal surgery: evidence from a randomised controlled trial

Abstract

ObjectiveTo study the incidence of postoperative systemic inflammatory response syndrome (SIRS) following different antibiotic prophylaxis (ABP) regimens in retrograde intrarenal surgery (RIRS). Patients and MethodsSingle-centre, randomised, controlled trial (August 2014-September 2017) including 426 patients with renal stones with preoperative sterile urine managed by RIRS (ClinicalTrials.gov NCT02304822). Different ciprofloxacinbased ABP regimens were used and included a zero dose, single dose (30 min before surgery) or two doses (first dose at 30 min before RIRS and additional dose within 6 h after RIRS). The incidence of SIRS was compared using intentionto-treat (ITT) and per-protocol (PP) analyses. ResultsEach group enrolled 142 patients. In the ITT analysis, a zero dose of ABP was statistically similar to the two ABP regimes for the incidence of SIRS (9.9% vs single dose 4.9%, P = 0.112; vs two doses 4.2%, P = 0.062). There were also no relevant differences across groups in the PP analysis; no urosepsis was recorded. In subgroup analysis with stratification by stone area, the three regimens all had a low and similar incidence of SIRS for stones of ≤200 mm 2 in the ITT analysis with a sufficient power value (5.4% vs 6.2% vs 3.6%, P = 0.945 vs single dose and P = 0.553 vs two doses). However, there was a greater chance of SIRS in patients who received no ABP with stones of >200 mm 2 (18% vs single dose 4.3%, P = 0.036; vs two doses 5.5%, P = 0.044). Similar trends were seen in the PP analysis. ConclusionsFor patients with preoperative sterile urine, ABP is not strongly recommended in patients with stones of ≤200 mm 2 , but for stones >200 mm 2 single-dose ABP is still required.

A nomogram for predicting postoperative urosepsis following retrograde intrarenal surgery in upper urinary calculi patients with negative preoperative urine culture

“…In the current study, despite the negative preoperative UC, 2.7% of patients developed urosepsis according to qSOFA. These results are consistent with a previous report on RIRS in patients with negative UC whose incidence of infection-related complications ranged from 0 ~ 17% 24 . Therefore, more attention should be given to postoperative infection after RIRS in patients, despite negative preoperative UC.…”

“…However, drug resistance and opportunistic infections may increase with the overuse and misuse of antibiotics 22 . Moreover, the consensus on antibiotic prophylaxis in the treatment of endoscopic calculi remains controversial, especially in patients with preoperative sterile urine 23 , 24 . To the best of our knowledge, the analysis of risk factors associated with postoperative infectious complications in patients with negative urine cultures after RIRS is still lacking.…”

Infectious complications of endourological treatment of kidney stones: A meta-analysis of randomized clinical trials

“…Out of the 12 remaining articles (51-62), one study compared perioperative antibiotic prophylaxis with a short course of antibiotics in patients at high risk for infectious complications (51), 5 studies (52-56) compared the effect of perioperative antibiotic prophylaxis with a single dose (or with two doses 24-48 hours apart) with a more complex strategy associating perioperative prophylaxis with a short course of antibiotic in the preoperative or postoperative period, 2 studies compared the results of perioperative prophylaxis with different antibiotics (57,58), and 2 studies compared both perioperative prophylaxis with different antibiotics and different strategies of antibiotic prophylaxis (59,60). Finally, two randomized placebo-controlled studies evaluated the outcome of antibiotic prophylaxis in patients who underwent PCNL or RIRS (61,62).…”

“…Two studies were retrieved and not pooled, as they compared different antibacterial agents with placebo (61,62).…”

“…A study presented the results of preoperative prophylaxis of RIRS with ciprofloxacin compared with placebo (62).…”