Comparison of Infection and Urosepsis Rates of Ciprofloxacin and Ceftriaxone Prophylaxis before Percutaneous Nephrolithotomy: A Prospective and Randomised Study

Abstract

This study aimed at determining the choice and administration duration of ideal antibiotic prophylaxis before percutaneous nephrolithotomy (PNL) operation, a treatment modality for nephrolithiasis. The study included 90 patients who had no internal problem, yet had a negative urine culture and underwent a PNL operation. We compared infection rates between ciprofloxacin and ceftriaxone groups and their subgroups. The results showed no statistical difference between ciprofloxacin and ceftriaxone groups in terms of systemic inflammatory response syndrome (SIRS) (CIPP = 0.306, CTX P = 0.334. As a result of this study no statistical difference was observed between ciprofloxacin and ceftriaxone in terms of SIRS. It seems, however, reasonable to choose ceftriaxone, considering antibiotic sensitivity of microorganisms and detection of three cases accepted as urosepsis in the ciprofloxacin group. As there is no difference between short, and long-term prophylactic use of these antibiotics, preference of short-term prophylaxis for patients with no risk of infection will be important to avoid inappropriate antibiotic usage.

Comparison of Ceftriaxone and Cefazolin Sodium Antibiotic Prophylaxis in Terms of SIRS/Urosepsis Rates in Patients Undergoing Percutaneous Nephrolithotomy

“…Renal pelvis urine culture positivity, stone culture positivity, stone burden, duration of nephrostomy, using multiple accesses and increased duration of surgery were reported as the predictors of SIRS development (5,15,19). We found prolonged operation time in ceftriaxone group and renal pelvis urine culture positivity in cefazoline group is associated with development of SIRS.…”

“…The most common complications of PCNL were reported as fever (21-32.1%), hemorrhage requiring blood transfusion (11.2-17.5%) and extravasation (7.2%). Septic shock (0.3-4.7%), colon injuries (0.2-4.8%) and pleural injury (0-3.1%) were reported as rare major complications (4,14,15). Most commonly reported complications were grade 1 and 2 complications according to the modified Clavien grading system (16).…”

“…This is usually in the form of beginning before surgery and continuing for 48 hours. However, in cases with sterile pre operative urine culture and with no predictive risk factors for upper tract infections, there are studies reporting that single use of preoperative antibiotic administration would be sufficient (15,19). As those reports may represent a different geographic antibiotic resistance pattern and local bacterial resistance to antibiotics is a major problem in our country, our clinical approach is to keep the patient on i.v antibiotics until the nephrostomy tube is withdrawn.…”

Can Neutrophil Count, Lymhocyte Count and Neutrophil-tolymphocyte Ratio Predict Fever Following Percutaneous Nephrolithotomy in Patients Without Risk Factors?

“…There is a general tendency to apply a short-term antibiotic course, which typically lasts 48 hours after PCNL (15). However, as we showed in our previous study, application of a single-dose preoperative antibiotic is sufficient in patients with a clean preoperative urine culture and no risk factor for upper urinary system infection (16).…”

“…Also, the fact that two different antibiotics were used for prophylaxis is another limiting factor in this study. Many studies showed that sepsis rates are not different for ceftriaxone and ciprofloxacin (16). Moreover, fluoroquinolones are not recommended anymore due to potential side effects in the current Urological Infection Guideline by the European Urology Association (23).…”