Extended Antibiotics for Ureteroscopy: More Risk, No Benefit

What is it about?

This study compared the susceptibility profiles of nosocomial bacteria in patients undergoing endoscopic flexible ureterolithotomy (fURS) with negative urine culture (UC) who received extended antibiotic prophylaxis (EP) versus standard antibiotic prophylaxis (SP). Overall, 10.3% of patients had complications, with 7.2% having postoperative urinary infection, 1.8% having upper UTI, and 1.4% having urinary sepsis. The risk of upper UTI and sepsis did not show significant differences between the two groups. However, patients with extended prophylaxis had a two times higher risk of low UTI than those with standard prophylaxis. The risk of MDRB isolation in the postoperative UC was higher in the extended prophylaxis group. The study concluded that standard 60-min preoperative prophylaxis is recommended.

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Why is it important?

This research is important because it aims to improve susceptibility profiles of nosocomial bacteria by identifying the difference between infectious complications in patients undergoing endoscopic flexible ureterolithotomy (fURS) with negative urine culture (UC) that received extended antibiotic prophylaxis (EP) compared with standard antibiotic prophylaxis (SP). The study found that patients with negative UC who underwent fURS using extended prophylaxis have two times higher risk of lower UTI than patients with standard prophylaxis, without differences in the incidence of upper UTI or urinary sepsis. The risk of MDRB isolation in the postoperative UC is higher in the extended prophylaxis group, therefore we recommend the standard 60-min preoperative prophylaxis. Key Takeaways: 1. In patients with negative UC who underwent fURS, the overall incidence of infectious complications was 10.3%. 2. Postoperative urinary infection occurred in 7.2% of patients, with lower UTI being significantly more likely in the extended prophylaxis group (6.8% versus 2.7%). 3. The risk of upper UTI and sepsis did not show significant differences between the extended and standard prophylaxis groups. 4. The risk of MDRB isolation in the postoperative UC was higher in the extended prophylaxis group. 5. The study recommends standard 60-min preoperative prophylaxis to reduce the risk of lower UTI and isolation of multidrug-resistant bacteria.