Antibiotic prophylaxis in percutaneous nephrostomy placements and replacements for malignant urinary tract obstruction. Retrospective cohort study with systematic review and meta-analysis

Introduction Percutaneous nephrostomy (PN) can lead to urinary tract infections (UTIs), but these can be prevented by administering antibiotics. However, the effectiveness of this approach is debated. Methods To evaluate the association between PN-related UTIs and antibiotic prophylaxis in cancer patients. This is a hybrid study was designed. A retrospective cohort study was conducted on cancer patients requiring PN, comparing antibiotic prophylaxis with no prophylaxis. The outcome, UTI, was measured up to seven days after the procedure. This cohort study was included in a systematic review and meta-analysis, for which random-effects models were used to synthesize the outcomes. Results 734 PN procedures were performed. The UTI rate following antibiotic prophylaxis was 0/158 for catheter placement and 3/66 (4.5%; p = 0.025) without prophylaxis. For catheter replacement, the UTI rate was 10/229 (4.4%) with prophylaxis and 2/67 (3.0%; p > 0.999) without. Nineteen studies with 4,606 patients were included. The binary meta-analysis included five studies and this cohort, with an odds ratio (OR) of 0.883 (95% CI = 0.400-1.951; I 2 = 50.2%) for UTI. These studies had a moderate to critical risk of bias. Discussion Antibiotics may only protect against UTIs during PN catheter placement, but this was not confirmed by the meta-analysis. A randomized clinical trial is needed. Conclusion Antibiotics may only protect against UTIs during PN catheter placement, but this was not confirmed by the meta-analysis. A randomized clinical trial is needed. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42021231063 , ClinicalTrials.gov NCT06801405 and PROSPERO CRD42021231063.