Chew BH, et al. - Authors conducted a rigorous (using CONSORT guidelines), multi-institutional trial to evaluate preoperative antibiotics in prior to percutaneous nephrolithotomy (PCNL) patients at low risk of developing infections. In PCNL patients at “low risk” for infectious complications, no advantage of providing 1 week of preoperative oral antibiotics was seen. Experts noted the peri-operative antibiotics per the American Urological Association (AUA) Best Practice Statement to be sufficient.

Methods

• Experts enrolled the “low risk” patients (negative pre-operative urine cultures and without any urinary drains) undergoing PCNL in a randomized controlled trial.
• They randomized the subjects to nitrofurantoin 100 mg BID for 7 days preceding surgery (n=43) and control arm with no oral antibiotics (n=43).
• Peri-operative doses of ampicillin and gentamicin was received by all subjects received.
• Urologists blinded to randomization performed prone PCNL.
• Development of sepsis was the primary outcome.

Results

• As per results 86 subjects were enrolled.
• Between treatment and control cohorts pre-operative patient characteristics were similar (stone size 19mm and 17mm, p=0.47).
• No differences were demonstrated by intra-operative characteristics.
• Findings suggested that the rate of sepsis was not statistically different between the treatment and control groups (12% and 14%, 95% CI [-0.163, 0.122], p=1.0).
• Authors noted other infectious parameters and complications to be similar (intensive care admission, fever, hypotension, leukocytosis).