MP10-10 INFECTIOUS COMPLICATIONS FOLLOWING URETEROSCOPY IN PATIENTS TREATED WITH ALTERNATIVE ANTIMICROBIAL PROPHYLAXIS

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder I1 Apr 2018MP10-10 INFECTIOUS COMPLICATIONS FOLLOWING URETEROSCOPY IN PATIENTS TREATED WITH ALTERNATIVE ANTIMICROBIAL PROPHYLAXIS Dimitri Papagiannopoulos, Seth K. Bechis, Kathryn Tringale, Joel E. Abbott, Kaivon Sobhani, Daniel Han, and Roger L. Sur Dimitri PapagiannopoulosDimitri Papagiannopoulos More articles by this author , Seth K. BechisSeth K. Bechis More articles by this author , Kathryn TringaleKathryn Tringale More articles by this author , Joel E. AbbottJoel E. Abbott More articles by this author , Kaivon SobhaniKaivon Sobhani More articles by this author , Daniel HanDaniel Han More articles by this author , and Roger L. SurRoger L. Sur More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.356AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES According to the AUA Best Practice Statement, fluoroquinolones (FQs) are an ″antimicrobial of choice″ for ureteroscopy. However, FQ resistance is on the rise. Based on 2013 data, our local antibiogram reports that Escherichia Coli resistance rates are 25%, and much higher (57%) in patients undergoing percutaneous nephrolithotomy. Based on these levels of resistance, FQ prophylaxis is no longer first-line in our department. We employ ″alternative antimicrobials″ as recommended by the AUA Best Practice Statement. A prospectively maintained ureteroscopy database was created and we evaluated infectious complications following use of these agents. METHODS With IRB (#160453) approved protocol, consecutive adult patients who underwent ureteroscopy for nephrolithiasis were consented for enrollment between June 2016 and January 2017. Patients received alternate antimicrobial prophylaxis as suggested by the AUA: ampicillin (vancomycin if penicillin allergic) and gentamicin (5 mg/kg ideal body weight) (ceftriaxone if GFR ≤60 [units]). Patient allergies, renal function, and previous urine cultures were also used to guide prophylaxis. 30-day infectious complications and readmission rates were reported. RESULTS 76 subjects were enrolled but 65 patients met inclusion criteria. In total, 89.2% (58/65) had a sterile pre-operative urine culture. Antibiotic prophylaxis choice is listed in Table 1. In those patients who had a postoperative urine culture, 84.1% (37/44) maintained sterile urine. Over the 30-day postoperative period, 15 patients (23.1%) had complications, of which 10 (15.4%) were infectious in etiology: 8 symptomatic urinary tract infections, 2 cases of sepsis. Readmission occurred in 6 (9.2%) cases. CONCLUSIONS In patients undergoing ureteroscopy for urolithiasis, who received alternative prophylaxis according to the AUA Best Practice Statement, infectious complications were reported in 15.4% of cases. This incidence is surprisingly high and may be reflective of a tertiary care experience with higher-risk patients. However, it may also suggest that alternative prophylaxis, which is largely generalized from other surgical experiences and our knowledge of genitourinary flora may require more vigorous validation and be tailored to account for local antibiograms. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e119-e120 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Dimitri Papagiannopoulos More articles by this author Seth K. Bechis More articles by this author Kathryn Tringale More articles by this author Joel E. Abbott More articles by this author Kaivon Sobhani More articles by this author Daniel Han More articles by this author Roger L. Sur More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...