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

Abstract

Introduction: There are controversies in the literature regarding the need for and duration of antibiotic prophylaxis in patients treated with extracorporeal shock wave lithotripsy (ESWL) who have a negative urine culture before treatment. In order to determine the efficacy of antibiotic prophylaxis in ESWL treatment of patients with proven sterile urine, a radnomized trial was performed. Methods: Patients were randomized for placebo and 1 or 7 days antibiotic prophylaxis (cefuroxime or ciprofloxacin), starting 30 min before ESWL. Post-ESWL studies (immediately and 2 and 6 weeks after ESWL) included patient history, urine culture and Gram stain. Results: After 2 weeks 20% of the patients and after 6 weeks 23% of the patients had bacteriuria, but there was no statistical significance between patients treated with placebo or those receiving prophylactic treatment. Only 2-3% of the patients (in the prophylaxis and placebo group) had clinical and bacteriological signs of a urinary tract infection, either 2 or 6 weeks after ESWL, possibly caused by re-infection, however, since bacteria were found in none of the urine samples collected directly after ESWL. There was no beneficial effect of antibiotic prophylaxis in the prevention of urinary tract infections in patients with a nephrostomy catheter or dilatation at the site of treatment. Conclusion: We conclude that in patients with urine proven sterile prior to ESWL there is no need for antibiotic prophylaxis.

Chronic urine acidification by fludrocortisone to treat infectious kidney stones

“…Antibiotics have a pertinent role pre-operatively, post-operatively and potentially in the presence of residual stone fragments. However, evidence for specific antibiotic regimens is lacking and guidelines are not prescriptive regarding the nature of the molecules to be used, their dose and duration of treatment [26][27][28][29]. Other treatment strategies have failed.…”

Screening for Significant Bacteriuria in Patients with Upper Tract Calculi Using Dipstick Urine Analysis

“…Bierkens et al defined a sterile urine as one with less than 10 4 cfu/mL in pure growth of a single organism or mixed growth of no more than two organisms associated with greater than 5 WBC per high-power field. 5 Other authors have failed to define "sterile urine" or employed the criteria defined by Kass using "sterile urine" and "no significant bacteriuria" as interchangeable terms. The population on which Kass derived his criteria were strictly defined.…”

“…For this study, significant bacteriuria was defined as one with greater than 10 4 cfu/mL in pure culture associated with greater than 5 WBC per high-power field. 5 A negative culture was one that had no growth or no significant growth (less than 10 4 cfu/mL). Positive culture was one that had greater than 10 4 cfu/mL in pure culture with greater than 5 WBC per high-power field.…”

“…1,2 However, it would appear that in those patients with sterile urine or insignificant bacteriuria defined as less than 10 4 cfu/mL in pure growth and less than 5 WBC per high-power field, antibiotic prophylaxis is unjustified. [3][4][5][6][7] While this makes good sense, the problem remains as to how to identify those patients with infected urine at the time of treatment. Laboratory assessment of microscopy, and semiquantitative culture is time consuming.…”

Complications of Urinary Stone Surgery

“…They concluded that although prophylactic antimicrobial therapy was justifiable among patients with a history of UTI or a suspected struvite stone, even in the absence of bacteriuria, it was of little value in patients with a calcium oxalate or calcium phosphate stone. Bierkens et al (68), in a prospective, placebo-controlled randomized study corroborated these findings. They noted that in a group of patients with documented sterile urine who received prophylactic antibiotics immediately before and after SWL, and a controlled group, the incidence of pyuria or bacteriuria did not change and that in both groups only 2-3% of the patients eventually had clinical and bacteriological signs of a UTI within 6 wk of SWL.…”