Objective: To explore the efficacy of antibiotic prophylaxis in perioperative period of percutaneous nephrolithotomy (PCNL) by conducting a systematic review and meta-analysis.
Materials and methods: A systematic literature search using Pubmed, Embase, and the Chinese SinoMed, CNKI, WanFang and VIP databases was performed to find comparative studies on the efficacy of different antibiotic prophylaxis strategies in PCNL for preventing postoperative sepsis. The last search was conducted on 21 April 2019. All selected articles were reviewed independently by two, and in case of discordance, three reviewers. Summarized unadjusted odds ratios (ORs) or risk ratios (RRs) with 95% confidence intervals (CIs) were calculated to assess the efficacy of different antibiotic prophylaxis strategies.
Results: Thirteen independent studies comprising up to 1549 individuals were included. Compared with single dose before anesthesia, preoperative prophylactic antibiotics significantly reduced postoperative sepsis (OR 0.31, 95% CI 0.20-0.50; P < 0.00001) and fever (OR 0.26, 95% CI 0.14-0.48; P < 0.0001). But no remarkable difference in sepsis risk between patients with and without postoperative prophylactic antibiotics was detected (RR 1.19, 95% CI 0.72-1.97; P = 0.49). And patients receiving postoperative prophylactic antibiotics were at a significantly high risk of fever (OR 1.88, 95% CI 1.01-3.05; P = 0.05). Compared with single dose before anesthesia, preoperative prophylactic antibiotics significantly reduced positive pelvic urine (RR 0.22, 95% CI 0.09-0.54; P = 0.0009) and stone cultures (RR 0.40, 95% CI 0.25-0.64; P = 0.0001).
Conclusions: The conclusion is drawn that preoperative prophylactic antibiotics indeed lowered the risk of postoperative sepsis and fever, whereas its postoperative use seems unnecessary. Besides, preoperative prophylactic antibiotics reduced positive pelvic urine and stone cultures significantly, which are a risk factor for sepsis. In our meta-analysis, the efficacy of different types of antibiotics and different courses of preoperative antibiotics could not be assessed. To verify the correctness of these conclusions, randomized controlled trials with a larger sample size and more rigorous study design are required.
Keywords: Antibiotics; Percutaneous nephrolithotomy; Prophylaxis; Sepsis.
Antibiotic Prophylaxis in Ureteroscopic Lithotripsy: A Systematic Review and Meta-Analysis of Comparative StudiesT Deng et al. BJU Int 122 (1), 29-39. PMID 29232047. - Meta-AnalysisWe concluded that preoperative antibiotic prophylaxis did not lower the risk of postoperative fUTI, but a single dose could reduce the incidence of pyuria or bacteriuria. …
A Randomized Controlled Trial of Preoperative Prophylactic Antibiotics Prior to Percutaneous Nephrolithotomy in a Low Infectious Risk Population: A Report From the EDGE ConsortiumBH Chew et al. J Urol 200 (4), 801-808. PMID 29684391. - Randomized Controlled TrialOur study demonstrated no advantage to providing 1 week of preoperative oral antibiotics in patients at low risk for infectious complications who undergo percutaneous nep …
Interventions for Replacing Missing Teeth: Antibiotics at Dental Implant Placement to Prevent ComplicationsM Esposito et al. Cochrane Database Syst Rev 2013 (7), CD004152. PMID 23904048. - ReviewScientific evidence suggests that, in general, antibiotics are beneficial for reducing failure of dental implants placed in ordinary conditions. Specifically 2 g or 3 g o …
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[Prophylatic Antibiotic Use in Percutaneous Nephrolithotomy: A Meta-Analysis]MG Yang et al. Zhonghua Wai Ke Za Zhi 51 (10), 922-7. PMID 24433773. - Meta-AnalysisProphylactic antibiotics can significantly decrease the incidence of postoperative infective complications. A significant decrease in bacteriuria incidence can be achieve …