Alexander CE et al, 2016: Routine Antibiotic Prophylaxis Is Not Required for Patients Undergoing Shockwave Lithotripsy: Outcomes from a National Shockwave Lithotripsy Database in New Zealand.
Alexander CE, Gowland S, Cadwallader J, Hopkins D, Reynard JM, Turney BW.
School of Medicine and Dentistry, University of Aberdeen , Aberdeen, United Kingdom.
Mobile Medical Technology , Christchurch, New Zealand.
Mobile Medical Technology , Auckland, New Zealand.
Oxford Stone Group, Department of Urology, Nuffield Department of Surgical Sciences, The Churchill Hospital , Oxford, United Kingdom.
PURPOSE: To assess the effectiveness of routine prophylactic antibiotics in the prevention of urinary tract infection (UTI) after extracorporeal shockwave lithotripsy (SWL) and identify predictors of UTI development in a multicenter series of over 10,000 stone cases treated in New Zealand over a 20-year period.
MATERIALS AND METHODS: Patients treated with SWL on the Mobile Medical Technology vehicle between June 19, 1995 and December 1, 2014 were identified. Data collection was undertaken prospectively for patient, stone and treatment characteristics, and, retrospectively, for treatment outcomes. The primary outcome was clinical UTI, defined as development of UTI symptoms requiring antibiotic therapy. Secondary outcomes included urinary sepsis, need for hospital admission due to infectious complications, and length of hospital stay. Multivariate analysis was undertaken to identify factors independently associated with the development of post-SWL UTI.
RESULTS: Antibiotic prophylaxis was used in 62.1% (n = 6710) of cases. On comparing patients who received prophylactic antibiotics to those in whom antibiotics were withheld, no significant differences were observed in terms of post-SWL UTI (1.1% vs 1.3%, p = 0.335) or urinary sepsis (0.04% vs 0.15%, p = 0.075). The use of prophylactic antibiotics was not independently associated with post-SWL UTI (OR: 1.269, 95% CI: 0.886-1.818, p = 0.194). Female gender, larger stone size, and higher number of delivered shocks were predictive of UTI development, but antibiotic prophylaxis did not appear to offer any benefit in this subgroup.
CONCLUSIONS: Routine antibiotic prophylaxis was not associated with a reduction in clinical UTI after SWL in this cohort of over 10,000 stone cases in New Zealand.
J Endourol. 2016 Nov;30(11):1233-1238.
The 2016 EAU Urolithiasis Guideline states in the ESWL section:
No standard antibiotic prophylaxis before SWL is recommended. However, prophylaxis is recommended in the case of internal stent placement ahead of anticipated treatments and in the presence of increased bacterial burden (e.g., indwelling catheter, nephrostomy tube, or infectious stones).
In the case of infected stones or bacteriuria, prescribe antibiotics prior to SWL. (LE: 4; GR:C)