Enhanced guideline-compliant antimicrobial prophylaxis based on preoperative urine culture pathogens reduces bloodstream infection and sepsis following ureteroscopic lithotripsy

Abstract

Introduction: Positive preoperative urine culture is a risk factor for infection after ureteroscopic lithotripsy (URSL). However, the effectiveness of tailoring antimicrobial prophylaxis (AP) to pathogens identified in preoperative urine culture remains unclear. This study aimed to evaluate whether three AP strategies reduce bloodstream infections and sepsis following URSL.

Methods: This single-center retrospective observational study was conducted between April 2019 and March 2025 at Komaki City Hospital, Japan. AP was classified into three categories: guideline-compliant AP (GC-AP, which do not cover all detected pathogens), pathogen-directed AP (PD-AP, which cover all pathogens but is non-guideline-compliant), and enhanced GC-AP (GC-AP or AP with an extended spectrum of antibiotics to which all pathogens detected in the preoperative urine culture are susceptible). The incidences of bloodstream infections and sepsis after URSL were compared among the three groups. The risk factors for postoperative sepsis were analyzed using multivariable logistic analysis.

Results: The enhanced GC-AP group had fewer bloodstream infections than the GC-AP group (0.67% [1/149] vs. 8.11% [6/74], p = 0.0059). No bloodstream infections were observed in the PD-AP group. However, the incidence of sepsis was significantly higher in the PD-AP group than in the enhanced GC-AP group (28.6% [8/28] vs. 10.7% [16/149], p = 0.030). Multivariable analysis showed that enhanced GC-AP significantly reduced the incidence of sepsis after URSL (odds ratio: 0.41, 95% confidence interval: 0.18-0.93, p = 0.023).

Conclusions: Enhanced GC-AP reduced bloodstream infections and sepsis after URSL.

Keywords: Antimicrobial prophylaxis; Bloodstream infection; Lithotripsy; Sepsis; Ureteroscopy.