Key result
Postoperative fever and urosepsis occurred in 25% and 3.9% of patients undergoing percutaneous nephrolithotripsy, respectively, with most bacterial isolates showing resistance to prophylactic ceftriaxone.
Why the study?
Percutaneous nephrolithotripsy carries significant infectious perioperative complications, making a local antibiogram essential to optimize antibiotic prophylaxis amid worldwide variation in bacterial distribution and antibiotic sensitivity.
Cohort (n=102)
No
In patients undergoing PCNL, there is a high rate of resistance to standard ceftriaxone prophylaxis, suggesting a need to shift to antibiotics with better Pseudomonas coverage.
High fever and urosepsis rates with ceftriaxone-resistant isolates after PCNL; hypothesis-generating for alternative prophylaxis, prospective trials needed.
Background. Despite being a clean-contaminated procedure, performed only in patients with sterile urine preoperatively, percutaneous nephrolithotripsy (PCNL) is associated with significant infectious perioperative complications. A local antibiogram is of paramount importance in optimizing antibiotic prophylaxis in PCNL because of the substantial variation in bacterial distribution and antibiotic sensitivity worldwide. Objectives. The incidence of post-PCNL infectious complications, microorganism distribution, and antibiotic sensitivities from patients admitted for PCNL was determined. The risk factors associated with positive cultures and the development of fever and bacteremia were also analyzed. Methods. A retrospective study of 102 patients who underwent PCNL under a surveillance protocol was done. The susceptibility of isolates from different specimens was evaluated against the most common antibiotics in the hospital. Chi-square and Student’s t-test were used to determine differences in the frequencies and means for other risk factors for those who developed fever and urosepsis and those who did not. Results. The incidence of fever and urosepsis was 25% and 4%, respectively. The most common organism on urine specimens was Escherichia coli which showed high sensitivity to aminoglycosides. The most common isolate on stones was Pseudomonas aeruginosa, which showed higher sensitivities to the fluoroquinolones. The isolates showed nearly consistent resistance to ceftriaxone. No significant association was found between the clinical variables studied and the occurrence of infectious complications. Conclusion. There are comparable rates of infectious complications to published literature. A change in antibiotic prophylaxis was warranted, given the high resistance to ceftriaxone and the predominance of Pseudomonas aeruginosa on stone isolates. Further surveillance is required to identify significant risk factors for the development of post-PCNL infectious complications.
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Flor et al. (2022) conducted a cohort in Renal stones requiring percutaneous nephrolithotripsy (n=102). Percutaneous nephrolithotripsy (PCNL) was evaluated on Incidence of postoperative fever. Postoperative fever and urosepsis occurred in 25% and 3.9% of patients undergoing percutaneous nephrolithotripsy, respectively, with most bacterial isolates showing resistance to prophylactic ceftriaxone.
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