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992: Tailored optimal perioperative antimicrobial prophylaxis in retrograde intrarenal surgery: Evidence from a prospective randomized trial

Speaker
G. Zeng, Guangzhou (CN)
Authors
Zeng G.
Institutions
The First Affiliated Hospital of Guangzhou Medical University, Dept. of Urology, Guangzhou, China, 0
Event
33rd Annual EAU Congress Copenhagen
Date – time - Location
19 March 2018, 14:00 - 15:30, Green Area, Room 1 (Level 0)
Session
Poster Session 73 - Safe access through natural orifice: It is the era of ureteroscopy
Topic
Stones: Ureteroscopy

Introduction & Objectives

To present a prospective randomize trail in comparison of multiple-, single-, zero-dose antibiotic prophylaxis in RIRS, and investigate the ideal protocol for antibiotic prophylaxis in RIRS.

Materials & Methods

A prospective randomized trial was conducted between August 2014 and November 2016. 300 consecutive patients with preoperative sterile urine undergoing RIRS were randomized into three groups and received ciprofloxacin-based different ABP regimes (group 1, zero-dose; group 2, single dose, 30 min before the surgery; group 3, two doses, first dose at 30 min before the surgery and additional dose within 12 hours after surgery. The primary endpoint was the systemic inflammatory response syndrome (SIRS).

Results

A total of 265 patients (group 1: 88, group 2: 88, group 3:89) were eligible for final analysis. Baseline characteristics were similar between three groups. SIRS was recorded in 8 (9.1%), 3 (3.4%) and 1(1.2%) patients in group 1, 2, 3, respectively. In subgroup analysis, SIRS occurred respectively in 5.0%, 5.1% and 0% of patients with stones ≤ 200 mm2; for stones > 200 mm2, low rates of SIRS were still observed in group 2 (0%) and group 3 (2.7%), however, 17.9% were developed in group 1. No urosepsis was developed in any groups.

Conclusions

RIRS without antibiotic prophylaxis is safe for patients with with preoperative sterile urine and stones ≤200 mm2, and prophylactic antibiotics are not recommended for those patients. However, single dose prophylaxis seems necessary and sufficient for patients with stones >200 mm2.