Antibiotic prophylaxis in perioperative period of percutaneous nephrolithotomy: a systematic review and meta-analysis of comparative studies

Abstract

Objective To explore the efficacy of antibiotic prophylaxis in perioperative period of percutaneous nephrolithotomy (PCNL) by conducting a systematic review and meta-analysis. Materials and methods A systematic literature search using Pubmed, Embase, and the Chinese SinoMed, CNKI, WanFang and VIP databases was performed to find comparative studies on the efficacy of different antibiotic prophylaxis strategies in PCNL for preventing postoperative sepsis. The last search was conducted on 21 April 2019. All selected articles were reviewed independently by two, and in case of discordance, three reviewers. Summarized unadjusted odds ratios (ORs) or risk ratios (RRs) with 95% confidence intervals (CIs) were calculated to assess the efficacy of different antibiotic prophylaxis strategies. Results Thirteen independent studies comprising up to 1549 individuals were included. Compared with single dose before anesthesia, preoperative prophylactic antibiotics significantly reduced postoperative sepsis (OR 0.31, 95% CI 0.20-0.50; P < 0.00001) and fever (OR 0.26, 95% CI 0.14-0.48; P < 0.0001). But no remarkable difference in sepsis risk between patients with and without postoperative prophylactic antibiotics was detected (RR 1.19, 95% CI 0.72-1.97; P = 0.49). And patients receiving postoperative prophylactic antibiotics were at a significantly high risk of fever (OR 1.88, 95% CI 1.01-3.05; P = 0.05). Compared with single dose before anesthesia, preoperative prophylactic antibiotics significantly reduced positive pelvic urine (RR 0.22, 95% CI 0.09-0.54; P = 0.0009) and stone cultures (RR 0.40, 95% CI 0.25-0.64; P = 0.0001). Conclusions The conclusion is drawn that preoperative prophylactic antibiotics indeed lowered the risk of postoperative sepsis and fever, whereas its postoperative use seems unnecessary. Besides, preoperative prophylactic antibiotics reduced positive pelvic urine and stone cultures significantly, which are a risk factor for sepsis. In our meta-analysis, the efficacy of different types of antibiotics and different courses of preoperative antibiotics could not be assessed. To verify the correctness of these conclusions, randomized controlled trials with a larger sample size and more rigorous study design are required.

Risk factors for the fever after percutaneous nephrolithotomy: a retrospective analysis

“…Nevertheless, the temperature of normal saline is significantly lower than the body temperature, the fluid can take away many heat from the patient and keep the patient in a low body temperature state (29)(30)(31). And the longer the operation, the more serious the situation (32,33). Under the condition of hypothermia, the patient's cardiovascular function changes, coagulation function disorder, which can increase intraoperative blood loss and tissue damage (34,35).…”

Complications of Percutaneous Nephrolithotripsy (Literature Review)

“…Слід зазначити, що передопераційне введення антибіотиків знижує ризик розвитку сепсису та загострення пієлонефриту, тоді як введення антибактеріальних препаратів після операції суттєво не впливає на цей показник. Крім того, передопераційне введення антибіотиків знижує кількість позитивного бактеріологічного посіву сечі та бактеріологічного посіву каменів нирки і відповідно знижується рівень інфекційних ускладнень [45].…”

Original manuscript by Yu et al.: Antibiotic prophylaxis in perioperative period of percutaneous nephrolithotomy: a systematic review and meta‑analysis of comparative studies

“…With much interest, we read the meta-analysis by Yu et al [1]. The authors performed a comprehensive review and pooled analysis to assess the effectiveness of different antibiotic prophylaxis strategies on preventing postoperative infection complications.…”