Document Detail

A Prospective Study Examining the Incidence of Bacteriuria and Urinary Tract Infection Post-Shockwave Lithotripsy with Targeted Antibiotic Prophylaxis.
MedLine Citation:
PMID:  23276509     Owner:  NLM     Status:  Publisher    
PURPOSE: Controversy exists regarding antibiotic prophylaxis prior to shockwave lithotripsy (SWL). The American Urologic Association guideline recommends universal antibiotic prophylaxis, whereas the European Association of Urology guideline recommends prophylaxis only for select patients. Our objective was to evaluate the use of targeted antibiotic prophylaxis in preventing urinary tract infections (UTI), in patients undergoing SWL. MATERIALS AND METHODS: A prospective single cohort study was performed over six months, with patients undergoing SWL. All patients underwent urine dipstick and culture prior to SWL. Targeted antibiotic prophylaxis was provided at the discretion of the treating urologist. All patients then had a urine culture performed post-SWL and completed a survey documenting fevers or urinary symptoms. The primary outcome was the incidence of UTIs, urosepsis and asymptomatic bacteriuria (ASB) post-SWL. The secondary outcome was the sensitivity and specificity of urinary dipstick leukocytes and nitrites. RESULTS: 526 patients were enrolled. Of the 389 patients included in the determination of the primary outcome only 1 (0.3%) patient developed a UTI, no patients developed urosepsis and 11 (2.8%) patients developed ASB. Eight (2.1%) patients were administered antibiotic prophylaxis. The specificity of urine dipstick nitrites was very high (95%), while the sensitivity was quite poor (9.7%). CONCLUSIONS: In our cohort study using targeted antibiotic prophylaxis, the rates of post-SWL UTI and ASB were extremely low, with no patients developing urosepsis. This questions the need for universal antibiotic prophylaxis prior to SWL.
R John D'A Honey; Michael Ordon; Daniela Ghiculete; Joshua D Wiesenthal; Ronald Kodama; Kenneth T Pace
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-28
Journal Detail:
Title:  The Journal of urology     Volume:  -     ISSN:  1527-3792     ISO Abbreviation:  J. Urol.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2013-1-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Division of Urology, St. Michael's Hospital, University of Toronto, Toronto, Canada. Electronic address:
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