Extended antimicrobial use in patients undergoing percutaneous nephrolithotomy and associated antibiotic related complications

Boyd R. Viers, Patrick A. Cockerill, Ramila A. Mehta, Eric J. Bergstralh, Amy E. Krambeck

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Purpose Despite global concern about antibiotic related complications the duration of antibiotic therapy at percutaneous nephrolithotomy varies based on individual physician practice. We evaluated perioperative antibiotic related complications in patients who received extended antimicrobial therapy at percutaneous nephrolithotomy.

Materials and Methods We reviewed the records of 227 consecutive patients treated with percutaneous nephrolithotomy from 2009 to 2013. Patients with positive urine or stone cultures received extended antimicrobial treatment. All others received 7 days of empirical therapy preoperatively and postoperatively. Adverse antibiotic related events were recorded for up to 3 months.

Results The median duration of antibiotic therapy was 14 days (IQR 14-34). Perioperatively 143 (63%), 67 (30%), 75 (33%) and 41 patients (18%) received nitrofurantoin, trimethoprim/sulfamethoxazole, fluoroquinolones and other antibiotics, respectively. Antibiotic related complications developed in 23 patients (10%) at a median of 12 days (IQR 8-19). Common complications included rash in 7 cases (3%), gastrointestinal upset in 6 (3%) and Clostridium difficile colitis in 1 (0.4%). Trimethoprim/sulfamethoxazole was associated with an increased likelihood of an adverse event (p = 0.04) but patient age, gender, and therapy type (therapeutic vs prophylactic) and duration were not. Finally, antibiotic and multidrug resistance developed in 4 (36%) and 3 patients (27%), respectively, who experienced a urinary tract infection.

Conclusions We report a low rate of adverse antibiotic related events in patients treated with percutaneous nephrolithotomy who received extended perioperative antibiotic therapy. Exposure to trimethoprim/sulfamethoxazole was the only identifiable risk factor for a complication. These findings should be considered when counseling patients on the risks of perioperative antimicrobial therapy at percutaneous nephrolithotomy.

Original languageEnglish (US)
Pages (from-to)1667-1672
Number of pages6
JournalJournal of Urology
Volume192
Issue number6
DOIs
StatePublished - Dec 1 2014
Externally publishedYes

Keywords

  • antibiotic prophylaxis
  • complications
  • kidney
  • nephrostomy
  • percutaneous
  • trimethoprim-sulfamethoxazole combination

ASJC Scopus subject areas

  • Urology

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