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Raynal G, Malval B, Panthier F, Roustan FR, Traxer O, Meria P, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Ureteroscopy and ureterorenoscopy. Prog Urol 2023; 33:843-853. [PMID: 37918983 DOI: 10.1016/j.purol.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
Technical advances, including miniaturization, have improved the deflection and optical performance of the ureteroscopes, and the availability of dedicated disposable devices have led to their increasing use for kidney and ureteral stone management. Ureterorenoscopy brings diagnostic evidence through the endoscopic description of stones and renal papillary abnormalities. Currently, intracorporeal lithotripsy during ureterorenoscopy is based on laser sources. Routine ureteral stenting is not necessary before ureterorenoscopy, especially because preoperative stenting for>30 days is considered as an independent risk factor of infection. Ureteral access sheaths allow the easy and repeated access to the upper urinary tract and thus facilitate ureterorenoscopy. Their use improves vision, decreases intrarenal pressure, and possibly reduces the operative time, but they may cause ureteral injury. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether or not the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis [EAU 2022]) and their adaptability to the French context.
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Affiliation(s)
- G Raynal
- Department of urology, clinique Métivet, 48, rue d'Alsace Lorraine, 94100 Saint-Maur-des-Fossés, France
| | - B Malval
- Clinique Saint-Hilaire, Rouen, France
| | - F Panthier
- GRC lithiase, AP-HP, Sorbonne université, Paris, France; Laboratoire PIMM, Arts et Métiers Paris Tech, Paris, France
| | | | - O Traxer
- GRC lithiase, AP-HP, Sorbonne université, Paris, France; Laboratoire PIMM, Arts et Métiers Paris Tech, Paris, France
| | - P Meria
- Service d'urologie, hôpital Saint-Louis, AP-HP-centre université Paris Cité, Paris, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
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Méndez‐Guerrero DM, Buitrago‐Carrascal C, Puentes‐Bernal AF, Cruz‐Arévalo DA, Camacho ‐Nieto D, Calderón MA, Álvarez‐Restrepo JC, Brijaldo‐Carvajal MA, Perdomo‐Bernal N, Moreno‐Matson MC, Ibañez‐Pinilla M, Daza‐Vergara J. Antibiotic prophylaxis in flexible ureterorenoscopy with negative urine culture. BJUI COMPASS 2023; 4:688-694. [PMID: 37818028 PMCID: PMC10560613 DOI: 10.1002/bco2.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/05/2023] [Accepted: 03/19/2023] [Indexed: 10/12/2023] Open
Abstract
Objective To improve susceptibility profiles of nosocomial bacteria, identifying the difference between infectious complications in patients undergoing endoscopic flexible ureterolithotomy (fURS) with negative urine culture (UC) that received extended antibiotic prophylaxis (EP) compared with standard antibiotic prophylaxis (SP). Methodology This is a retrospective, observational, analytical cohort study, comparing infectious complications between patients undergoing fURS with negative UC who received EP versus SP. We include patients with susccessfull fURS, <20-mm stones and complete information. Results Overall, 10.3% of patients had complications, 7.2% of patients had postoperative urinary infection, 1.8% had upper urinary tract infection (UTI) and 1.4% had urinary sepsis. Lower UTI were significantly more likely in the extended prophylaxis group with 6.8% versus 2.7% (RR = 2.8; 95% CI: 1.10-7.37, p = 0.030). The risk of upper UTI and sepsis did not show significant differences. A total of 69% patients with postoperative infection had isolated multidrug-resistant bacteria (MDRB) in the UC, with a higher risk in patients with extended prophylaxis (RR = 3.1; 95% CI: 1.33-7.59, p = 0.009). Conclusions Patients with negative UC who underwent fURS using extended prophylaxis have two times higher risk of low UTI than patients with standard prophylaxis, without differences in the incidence of upper UTI or urinary sepsis. The risk of MDRB isolation in the postoperative UC is higher in the extended prophylaxis group, therefore we recommend the standard 60-min preoperative prophylaxis.
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Affiliation(s)
| | | | | | | | - Diego Camacho ‐Nieto
- Department of UrologyHospital Universitario Mayor Méderi ‐ Universidad del RosarioBogotáColombia
| | | | | | | | | | | | | | - José Daza‐Vergara
- Hospital Universitario Mayor Méderi ‐ Universidad del RosarioBogotáColombia
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El-Agamy ESI, Elhelaly MA, Abouelgreed TA, Abdrabuh AM, Elebiary MF, Elatreisy A, Ghoneimy OM, Fathi BA, Zamra M, Kutub K. Randomized comparison of effect of standard antibiotic prophylaxis versus enhanced prophylactic measures on rate of urinary tract infection after flexible ureteroscopy. Arch Ital Urol Androl 2023; 95:11084. [PMID: 36924374 DOI: 10.4081/aiua.2023.11084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/22/2023] [Indexed: 03/17/2023] Open
Abstract
PURPOSE To compare the rate of post-flexible ureteroscopy urinary tract infection (UTI) in patients subjected to the standard antibiotic prophylaxis alone versus enhanced prophylactic measures. METHODS A prospective randomized controlled study included 256 patients subjected to flexible ureteroscopy (FURS) for ureteral or renal stones from March 2018 to July 2022. Treatment groups included the standard antibiotic prophylaxis group (group 1, n=128) and the enhanced prophylaxis group (group 2, n=128). Patients in group 1 were injected with intravenous fluoroquinolone one hour preoperatively, and oral antibiotics were used for 24 h postoperatively. Patients in group 2 had urine culture ten days before the procedure; antibiotic-culture based was given for positive asymptomatic cases, while the procedure was deferred for active UTI. RESULTS The study groups were comparable regarding patient demographics, stone characteristics, operative time, and intraoperative complications. The overall hospitalization time was 1.68 ± 0.81 days. Postoperative, and overall complications were significantly higher in group 1 (15.6% vs. 6.3%, p = 0.04 and 26.6% vs. 17.2%, p = 0.047), respectively. Twenty patients (15.6 %) in the standard prophylaxis group were diagnosed with UTI in comparison to 8 patients (6.3 %) in the enhanced prophylaxis group (p = 0.047). CONCLUSIONS Urinary tract infection after FURS could be reduced significantly by utilizing the suggested enhanced prophylactic approach.
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Affiliation(s)
- El-Sayed I El-Agamy
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo; Department of Urology, Armed Forced Hospital, Alhada, KSA.
| | - Mohamed A Elhelaly
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo; Department of Urology, Armed Forced Hospital, Alhada, KSA.
| | - Tamer A Abouelgreed
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo; Gulf Medical University, UAE.
| | | | | | - Adel Elatreisy
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Osama M Ghoneimy
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Basem A Fathi
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo.
| | | | - Khalid Kutub
- Department of Urology, Al Aharq Jospital, Fujairah.
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Veeratterapillay R, Gravestock P, Harding C, Shaw M, Fitzpatrick J, Keltie K, Cognigni P, Sims A, Rogers A. Infection after ureteroscopy for ureteric stones: analysis of 71 305 cases in the Hospital Episode Statistics database. BJU Int 2023; 131:109-115. [PMID: 35844154 DOI: 10.1111/bju.15850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To investigate the burden of infectious complications following ureteroscopy (URS) for ureteric stones on a national level in England using data from the Hospital Episodes Statistics (HES) data warehouse. MATERIALS AND METHODS A retrospective cohort was identified and followed up in HES during the period April 2013 to March 2020 for all procedure codes relating to ureteroscopic stone treatment (M27.1, M27.2, M27.3). Treatment episodes relating to the first URS ('index ureteroscopy') for each patient were further analysed. All subsequent admissions within 30 days were also captured. The primary outcome was diagnosis of urinary tract infection (UTI; including all codes relating to a UTI/sepsis within the first 30 days of index URS). Secondary outcomes were critical care attendance, attendance at the accident and emergency department (A&E) within 30 days, and mortality. RESULTS A total of 71 305 index ureteroscopies were eligible for analysis. The median age was 55 years, and 81% of procedures were elective and 45% were undertaken as day-cases. At the time of index URS, 16% of patients had diabetes, 0.5% had coexisting neurological disease and 40% had an existing stent/nephrostomy. Overall, 6.8% of the cohort (n = 4822) had a diagnosis of UTI within 30 days of index URS (3.9% immediately after surgery). A total of 339 patients (0.5%) required an unplanned stay in critical care during their index URS admission; 8833 patients (12%) attended A&E within 30 days. Overall mortality was 0.18% (60 in-hospital, 65 within 30 days); 40 deaths (0.056%) included infection as a contributing cause of death. CONCLUSION We present the largest series evaluating infectious complications after ureteroscopic stone treatment. The procedure is safe, with low inpatient infective complication and critical care admission rates.
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Affiliation(s)
| | - Paul Gravestock
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Chris Harding
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Matthew Shaw
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John Fitzpatrick
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Kim Keltie
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Faculty of Medical Sciences, Translational and Clinical Research Institute, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Paola Cognigni
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Andrew Sims
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Faculty of Medical Sciences, Translational and Clinical Research Institute, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Alistair Rogers
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Granado BAR, Alexander B, Steinberg RL, Packiam VT, Lund BC, Livorsi DJ. Post-procedural Antibiotic Use and Associated Outcomes After Common Urologic Procedures Across a National Healthcare System. Urology 2023; 171:115-120. [PMID: 36334771 DOI: 10.1016/j.urology.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/26/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To quantify the benefits and harms of post-procedural antibiotic use after common urologic procedures. MATERIALS AND METHODS This retrospective cohort study included patients who underwent an endoscopic urologic procedure (transurethral resection of bladder tumor, transurethral resection of prostate, or ureteroscopy) within the Veterans Health Administration between January 1, 2017 and June 30, 2021. A post-procedural antibiotic was any qualifying antibiotic prescribed for administration on the day after the procedure. Guidelines generally do not recommend post-procedural antibiotics for surgical prophylaxis. Outcomes included unplanned return visits and Clostridioides difficile infection within 30 days. Log-binomial models with risk-adjustment were used to measure the association between post-procedural antibiotic use and outcomes. Hospital-level observed-to-expected (O:E) ratios were constructed to compare post-procedural antibiotic use. RESULTS There were 74,629 qualifying procedures across 105 hospitals; 27,422 (36.7%) received post-procedural antibiotics (median 3 days, IQR 3-6). An unplanned return visit occurred in 20.2% of patients who received post-procedural antibiotics vs 17.2% who did not (adjusted RR 1.032, 95% CI 0.999-1.066). C. difficile infection was diagnosed in 0.27% vs 0.10% in those who received and did not receive post-procedural antibiotics (adjusted RR 1.67, 95% CI 1.13-2.45). The O:E ratio for post-procedural antibiotic use ranged from 0.46 among hospitals in the lowest-use quartile to 1.93 in the highest-use quartile. CONCLUSION Post-procedural antibiotics were frequently prescribed after urologic procedures with large inter-facility variability even after adjusting for case-mix differences. Post-procedural antibiotic use was associated with increased risk for C. difficile infection but not fewer unplanned return visits. Efforts to reduce guideline-discordant use of post-procedural antibiotics are needed.
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Affiliation(s)
- Bibiana A R Granado
- Department of Pharmacy, Iowa City Veterans Affairs Health Care System, Iowa City, IA
| | - Bruce Alexander
- Department of Pharmacy, Iowa City Veterans Affairs Health Care System, Iowa City, IA
| | - Ryan L Steinberg
- Department of Urology, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Vignesh T Packiam
- Department of Urology, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Brian C Lund
- Department of Pharmacy, Iowa City Veterans Affairs Health Care System, Iowa City, IA
| | - Daniel J Livorsi
- Department of Pharmacy, Iowa City Veterans Affairs Health Care System, Iowa City, IA; Division of Infectious Diseases, University of Iowa Carver College of Medicine, Iowa City, IA.
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Chen H, Yin C, Zhang X, Zhu Y. Preparation and characterisation of bifunctional surface-modified silicone catheter in lumen. J Glob Antimicrob Resist 2020; 23:46-54. [PMID: 32795517 DOI: 10.1016/j.jgar.2020.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/08/2020] [Accepted: 07/20/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate the coating of antimicrobial peptides (AMPs) and polyvinylpyrrolidone (PVP) to the surface of a silicone catheter to reduce bacterial growth and to increase hydrophilicity, respectively. METHODS Surface characterisation was performed on bare silicone, AMP-coated, PVP-coated and AMP + PVP-coated silicone catheters using attenuated total reflectance-infrared (ATR-IR) spectroscopy, X-ray photoelectron spectroscopy (XPS) and water contact angle. Antibacterial activity, antibacterial biofilm growth and XTT assay were performed on bare silicone, AMP-coated, PVP-coated and AMP + PVP-coated silicone catheters. Statistical analysis was performed by one-way ANOVA. RESULTS The water contact angle of the AMP + PVP-coated silicone catheter was 21.37 ± 2.17° compared with 107.23 ± 0.96°, 74.40 ± 1.76° and 20.77 ± 0.32° for bare silicone, AMP-coated and PVP-coated silicone catheters. Based on in vitro antimicrobial tests, the AMP + PVP-coated silicone catheter had 6.2, 2.2 and 2.5 greater antibacterial activity than that of the bare silicone catheter against Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa, respectively. Moreover, bacterial biofilm growth on the surface of the AMP + PVP-coated silicone catheter was minimal as characterised by scanning electron microscopy. MTT assay showed that bare silicone, AMP-coated, AMP + PVP-coated and PVP-coated silicone catheters were non-cytotoxic to 3T3 and human colon cancer (Caco-2) cells. CONCLUSIONS This work demonstrates that AMP + PVP-coated silicone catheters have potential clinical application prospects with improved hydrophilicity, excellent biocompatibility, antibacterial activity and a certain antibacterial biofilm effect.
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Affiliation(s)
- Haiyan Chen
- College of Pharmaceutical Sciences, Nanjing Tech University, Nanjing 211816, China
| | - Caiyun Yin
- College of Pharmaceutical Sciences, Nanjing Tech University, Nanjing 211816, China
| | - Xin Zhang
- College of Pharmaceutical Sciences, Nanjing Tech University, Nanjing 211816, China
| | - Yishen Zhu
- College of Biotechnology and Pharmaceutical Engineering, Nanjing Tech University, Nanjing 211816, China.
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8
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Ofstead CL, Hopkins KM, Buro BL, Eiland JE, Wetzler HP. Challenges in achieving effective high-level disinfection in endoscope reprocessing. Am J Infect Control 2020; 48:309-315. [PMID: 31677925 DOI: 10.1016/j.ajic.2019.09.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 01/15/2023]
Abstract
Endoscope reprocessing is often ineffective, and microbes frequently remain on endoscopes after the use of high-level disinfectants (HLDs). Several factors impact reprocessing effectiveness, including non-adherence to guidelines, use of damaged endoscopes, use of insoluble products during endoscopy, insufficient cleaning, contaminated rinse water, and inadequate drying before storage. Our team suspected that issues with HLD chemistries and monitoring could also contribute to reprocessing failures. We conducted a mixed-methods analysis of published literature, our interviews with frontline personnel, and evidence from our previous studies. The evidence showed that reusable HLDs commonly failed tests for minimum effective concentration (MEC) before their maximum usage periods. MEC tests also detected failures associated with single-use HLDs that did not fully deploy. These failures were due to product issues, process complexities, and personnel non-adherence with guidelines and manufacturer instructions. HLDs will likely continue to be used for the foreseeable future. More research is needed to assess real-world practice patterns related to the high-level disinfection step and MEC testing and to establish more realistic usage periods for reusable HLD chemistries. Manufacturers and researchers should evaluate the ability of technological solutions and engineered safeguards to overcome human error. Recognition of the need for quality improvement is growing, and infection preventionists should take action to build on this momentum and collaborate with manufacturers, endoscopists, and reprocessing personnel to improve the effectiveness of high-level disinfection.
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Southern JB, Higgins AM, Young AJ, Kost KA, Schreiter BR, Clifton M, Fulmer BR, Garg T. Letter to the Editor RE: Meller, Editorial Comment on: Risk Factors for Postoperative Fever and Systemic Inflammatory Response Syndrome After Ureteroscopy for Stone Disease by Southern et al. (From: Meller A. J Endourol 2019;33:523-524; DOI: 10.1089/end.2019.0206). J Endourol 2019; 33:525-526. [PMID: 31233338 DOI: 10.1089/end.2019.29058.jbs] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Amanda J Young
- 2 Biostatistics Core, Biomedical and Translational Informatics Institute, Geisinger, Danville, Pennsylvania
| | - Korey A Kost
- 3 Phenomic Analytics and Clinical Data Core, Biomedical and Translational Informatics Institute, Geisinger, Danville, Pennsylvania
| | | | - Marisa Clifton
- 1 Department of Urology, Geisinger, Danville, Pennsylvania
| | - Brant R Fulmer
- 1 Department of Urology, Geisinger, Danville, Pennsylvania
| | - Tullika Garg
- 1 Department of Urology, Geisinger, Danville, Pennsylvania.,4 Department of Epidemiology and Health Services Research, Geisinger, Danville, Pennsylvania
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Ofstead CL, Hopkins KM, Eiland JE, Wetzler HP. Widespread clinical use of simethicone, insoluble lubricants, and tissue glue during endoscopy: A call to action for infection preventionists. Am J Infect Control 2019; 47:666-670. [PMID: 30922624 DOI: 10.1016/j.ajic.2019.02.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/10/2019] [Accepted: 02/11/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Current methods for reprocessing flexible endoscopes do not consistently eliminate organic soil. The off-label use of simethicone as a defoaming agent may contribute to reprocessing failures, and endoscope manufacturers have cautioned against its use. METHODS We sought evidence of simethicone use by interviewing hospital personnel, conducting audits, inspecting endoscopes, and conducting tests. RESULTS Researchers examined 69 fully reprocessed endoscopes in 4 hospitals. Microbial cultures were positive for ≥50% of endoscopes. Researchers observed cloudy, shimmery fluid resembling simethicone inside channels and under a duodenoscope elevator mechanism. Crystallized white fragments were observed protruding from a gastroscope water jet outlet. Oily, sticky residue was found on endoscopes, and a 3-dimensional mass was found inside an endoscopic ultrasound endoscope. Hospital personnel reported the use of simethicone, cooking oil and silicone sprays, and tissue glue during endoscopy. DISCUSSION The off-label use of defoaming agents, lubricants, and tissue glue is common and many endoscopists consider these products essential. Our findings suggest these substances are not removed during reprocessing and may impact reprocessing effectiveness. CONCLUSIONS Infection preventionists should determine whether these products are used in their institutions and evaluate methods for removing them. New policies may be needed to support procedural success and effective endoscope reprocessing.
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Abstract
PURPOSE OF REVIEW To give an overview about state-of-the-art antibiotic prophylaxis in urolithasis therapy and focus on recent publications in this field. RECENT FINDINGS The number of high-quality publications within the recent time is limited. Preoperative inflammatory blood parameters like C-reactive protein and erythrocyte-sedimentation rate might help in prediction of postoperative systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL). White blood cell count is nonpredictive for urinary tract infection (UTI) in patients with acute renal colic. In patients with low risk for infectious complications, antibiotic prophylaxis during shock-wave lithotripsy (SWL) is unnecessary and single-dose antibiotics are comparably effective as prolonged antibiotic usage during PCNL and ureterorenoscopy (URS). SUMMARY Current findings support the American Urological Association (AUA) and European Association of Urology (EAU) guideline recommendations for a risk-adapted minimal antibiotic usage. Single-dose antibiotic prophylaxis is sufficient for low-risk PCNL and URS. For SWL no antibiotic prophylaxis is needed.
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Comparison of guideline recommendations for antimicrobial prophylaxis in urologic procedures: variability, lack of consensus, and contradictions. Int Urol Nephrol 2018; 50:1923-1937. [DOI: 10.1007/s11255-018-1971-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 08/18/2018] [Indexed: 10/28/2022]
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Grabe MJ, Resman F. Antimicrobial Stewardship: What We All Just Need to Know. Eur Urol Focus 2018; 5:46-49. [PMID: 29970303 DOI: 10.1016/j.euf.2018.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 05/31/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
Abstract
CONTEXT Microbial resistance to antibiotics is increasing while antimicrobials are limited. Responsible use is necessary. OBJECTIVE Describe the present acquisitions of antimicrobial stewardship programmes (ASPs) in general and in urology. EVIDENCE SYNTHESIS Well-designed ASPs have an impact on reducing treatment duration, shortening intravenous treatment in favour of oral targeted therapy, and reducing the total antibiotic prescription. Moreover, the hospital length of stay can potentially be reduced without hazard for the patient. CONCLUSIONS It is recommended to set up an ASP for education and feedback as standard in urological practice. The exact design of the ASP should be tailored to regional prerequisites.
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Affiliation(s)
- Magnus J Grabe
- Department of Translational Medicine, Division of Urological Cancer, Lund University, Malmö, Sweden.
| | - Fredrik Resman
- Department of Translational Medicine, Clinical Infection Medicine, Lund University, Malmö, Sweden
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