Mira Moreno A et al, 2014: Incidence of Infectious Complications after Extracorporeal Shock Wave Lithotripsy in Patients Without Associated Risk Factors.
Mira Moreno A, Montoya Lirola MD, García Tabar PJ, Galiano Baena JF, Tenza Tenza JA, Lobato Encinas JJ
Urology Department, General Hospital University of Alicante, Alicante, Spain
Abstract
PURPOSE: To determine the incidence of infectious complications (asymptomatic bacteriuria, urinary tract infection and urosepsis) in subjects without associated risk factors treated with extracorporeal shock wave lithotripsy (SWL). MATERIAL AND METHODS: An observational prospective cohort study was carried out between October 2010, and June 2013. We included all subjects without risk factors treated with SWL for, kidney or ureteral lithiasis. All subjects underwent a urine culture five days prior the procedure and another one seven days after the SWL. None of the subjects included were treated with antibiotics. RESULTS: 366 subjects were initially enrolled. The mean age was 53+13 years. 64 subjects (17.5%) underwent SWL with previously placed double J stent. The urine culture post-SWL was positive in 20 patients (5.8%), 4 of them (1.2%) presented symptomatic urinary infection and the rest (4.6%) did not show any symptoms. None of the subjects developed rosepsis. In our case, the age has demostrate to be an independent risk factor for post-SWL bacteriuria. CONCLUSIONS: The incidence of infectious complications after SWL in subjects without risk factors is very low, which leads us to conclude that, without defined risk factors, antibiotic prophylaxis is not justified. We also demonstrate that elderly subjects have more risk for development of post-SWL bacteriuria and therefore a possible infectious complication.
J Urol. 2014 May 24. pii: S0022-5347(14)03684-2. doi: 10.1016/j.juro.2014.05.091. [Epub ahead of print]
Comments 1
In a review of 366 patients treated with SWL it was concluded that in the absence of specific risk-factors, infection preventive treatment with antibiotics is not necessary. It is reassuring that this result still confirms our findings reported 35 years ago [1]. It was also reported that the insertion of a stent was not an independent risk-factor, but 11.5% of patients with a stent had a positive urine culture compared with only 4.6% of patients without a stent. This finding emphasizes the importance of inserting stents under strictly sterile conditions.
Reference:
1. Pettersson B, Tiselius HG. Are prophylactic antibiotics necessary during extracorporeal shockwave lithotripsy? Br J Urol. 1989 63:449-452