Presented by: Wilson Sui
University of California, San Francisco

Introduction

Postoperative infections after ureteroscopy are common and potentially devastating complications. The AUA and EAU guidelines recommend treatment of symptomatic positive urine cultures, but how to apply these guidelines to high risk patients, who are often asymptomatic, remains unclear. To examine whether antibiotic duration impacts the infection rate, we evaluated our institutional practices and outcomes with regard to preoperative antibiotic use in high risk ureteroscopy patients. 

Materials

Our prospectively collected database, the Registry for Stones of the Kidney and Ureter, was queried for all patients undergoing ureteroscopy between 2015 and 2022. Perioperative urine culture results and antibiotic duration/choice were abstracted. Patients with a high likelihood of urinary colonization were identified (history of spinal cord injury, stroke, MS, paraplegia, bowel diversion, indwelling SPT or foley, or a stent/percutaneous nephrostomy in place for >30 days). Our primary outcome was postoperative infection, which was defined by urinary tract infection, pyelonephritis, systemic inflammatory response syndrome or fever within 30 days of surgery. 

Results

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A total of n = 884 patients met our inclusion criteria, 57% of whom were low risk while the rest were high risk. Duration of preoperative prophylactic antibiotic utilization was categorized into none, 1-3 days, 3-10 days and >10 days before the day of surgery for patients. The proportion of patients in each category were similar (Figure 1a). For all high-risk patients, the infectious complication rate ranged from 10% to 20% and there were no differences detected on univariate analysis. On multivariable analysis of predictors of postoperative infectious complications, only female sex (OR 1.938, 95% CI 1.183-3.324) was statistically significant.

Conclusion

The duration of preoperative antibiotics prior to ureteroscopy, even in high risk patients with positive urine cultures, did not reduce postoperative infectious complication rates. Further research is needed to identify alternative interventions to prevent postoperative infectious complications

Funding

None

Lead Authors

Ukrit Rompsaithong,
University of California, San Francisco

Co-Authors

Lejla Pepic,
University of California, San Francisco

Heiko Yang,
University of California, San Francisco

Kevin Chang,
University of California, San Francisco

Ashwin Balakrishnan,
University of California, San Francisco

David Bayne,
University of California, San Francisco

Justin Ahn,
University of California, San Francisco

Marshall Stoller,
University of California, San Francisco

Tom Chi,
University of California, San Francisco