Poster Presenter

Perioperative Antibiotic Prophylaxis In Retrograde Ureteroscopy: What And How Long?
C PRICOP, D MISCHIANU, F RUSU, D PUIA, C CIUTA
Romania

Introduction: Therapeutic and diagnostic retrograde ureteroscopy is one of the most frequent endourological procedures, but still there is a debate regarding the use of antibiotic prophylaxis in patients with pre-operative negative urine culture (NUC) in order to prevent urinary tract infection (UTI). This prospective, randomized, multicentric study tried to compare single-dose and short-course antibiotic prophylaxis protocols in ureteroscopy.

Methods: 2 Urological centres recruited 187 patients (mean age of 53.9 years old) with preoperative NUC who underwent a retrograde ureteroscopy and were prospectively randomized into 4 groups in terms of having antibiotic prophylaxis: group 1 - 47 patients without antibiotic prophylaxis, group 2 - 63 patients receiving ciprofloxacin (orally 1g/day for 3 days), group 3 - 40 patients receiving ceftriaxone (i.v. 2 g/day for 3 days) and group 4 - 37 patients receiving levofloxacin (one oral dose of 500 mg). All patients had urine analysis and urine cultures on the fifth day after the operation. Additionally, clinical parameters including fever and dysuria were recorded.

Results: Postoperative UTI (significant bacteriuria) was observed in 26 patients (13.9%). Urine cultures revealed the growth of E. coli in 67.9%, Proteus in 14.3%, Klebsiella in 10.7% of cases. UTI occurred in 8 patients (17%) in group 1, 9 cases (14.3%) in group 2, 5 cases (12.5%) in group 3 and 4 cases (10.8%) in group 4 (P = 0.86). All drugs were well tolerated. No statistically significant difference was observed between these groups based on the microbiological and clinical parameters. Patients with diabetes (9.6%) have a great risk for UTI (RR = 3.45, CI = 1.68-7.08, p = 0.005). Presence of stones larger than 1.3 cm at 15 patients (8%) increased the risk for UTI (RR=2.08, CI=0.82-5.27, p=0.08). Also recent history of UTI rised the rate of postoperative UTI (RR = 2.38, CI = 0.99-6.15, p = 0.06).

Conclusions: The current study provides evidence that in retrograde ureteroscopy correctly administered oral prophylaxis has been shown to be as effective as intravenous prophylaxis. Short-term prophylaxis has no advantage over single-dose prophylaxis as a means of preventing infection. Nonetheless, we agree that patients should have sterile urine at urological instrumentation and that any other detected risk factor should be controlled. Antibiotic prophylaxis should be considered to all patients at risk (diabetes, large stones, predictable laborious intervention, recent history of UTI) and it should be timed properly before the intervention. Levofloxacin, with a broad antimicrobial spectrum, favourable pharmacokinetic properties and easy to use, can be considered a valid and well tolerated therapeutic option for the antibacterial prophylaxis in endourological procedures, both in hospital and in outpatient setting.