Single dose of pre-operative intravenous antibiotic is sufficient for upper tract urolithiasis procedures

Abstract

Background: Infection is one of the major complications in endourological procedures, and may range in severity from mild fever to septic shock. A survey on postoperative antibiotic usage showed varied usage. No clear guidelines exist for the same. The objective of this study is to rationalise the usage of post-operative antibiotics in urine culture negative patients with symptomatic upper urinary tract calculi. Materials and Methods: A prospective randomised controlled study done from March 2021 to February 2022. A total of 250 cases operated for upper urinary tract calculi at our institution with sterile urine culture are considered. All the patients received only single dose of prophylactic antibiotic before surgery and no postoperative antibiotics were given. They were divided into 2 groups to assess the local antibiotic (gentamycin) implications in reducing the usage of post-operative antibiotics. Postoperatively fever was assessed along with other signs of infection like pyelonephritis, symptomatic urinary tract infection (UTI) and sepsis. Statistical analysis is done and p value <0.05 is considered significant. Results: A total of 19 patients (8%) developed fever among 250 patients. Among the 124 Percutaneous Nephrolithotomy (PCNL) patients, 11 developed fever and among 126 Ureterorenoscopic lithotripsy (URSL) patients, 8 developed fever. Overall fever incidence is similar with gentamycin (7.5%) or standard normal saline (NS) irrigation (7.7%). None of the patients developed pyelonephritis, UTI or sepsis. Conclusion: Single dose of pre-operative intravenous (IV) antibiotic is sufficient for upper tract urolithiasis procedures. There is no significant role of local antibiotic instillation in irrigation fluid, on the post-operative infections.

Keywords

• antibiotic usage; pcnl; ursl; upper tract urolithiasis