THE VALUE OF ANTIBIOTIC-PROPHYLAXIS DURING EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY IN THE PREVENTION OF URINARY-TRACT INFECTIONS IN PATIENTS WITH URINE PROVEN STERILE PRIOR TO TREATMENT
Af. Bierkens et al., THE VALUE OF ANTIBIOTIC-PROPHYLAXIS DURING EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY IN THE PREVENTION OF URINARY-TRACT INFECTIONS IN PATIENTS WITH URINE PROVEN STERILE PRIOR TO TREATMENT, European urology, 31(1), 1997, pp. 30-35
Introduction: There are controversies in the literature regarding the
need for and duration of antibiotic prophylaxis in patients treated wi
th extracorporeal shock wave lithotripsy (ESWL) who have a negative ur
ine culture before treatment. In order to determine the efficacy of an
tibiotic prophylaxis in ESWL treatment of patients with proven sterile
urine, a radnomized trial was performed. Methods: Patients were rando
mized for placebo and 1 or 7 days antibiotic prophylaxis (cefuroxime o
r ciprofloxacin), starting 30 min before ESWL. Post-ESWL studies (imme
diately and 2 and 6 weeks after ESWL) included patient history, urine
culture and Gram stain. Results: After 2 weeks 20% of the patients and
after 6 weeks 23% of the patients had bacteriuria, but there was no s
tatistical significance between patients treated with placebo or those
receiving prophylactic treatment. Only 2-3% of the patients (in the p
rophylaxis and placebo group) had clinical and bacteriological signs o
f a urinary tract infection, either 2 or 6 weeks after ESWL, possibly
caused by re-infection, however, since bacteria were found in none of
the urine samples collected directly after ESWL. There was no benefici
al effect of antibiotic prophylaxis in the prevention of urinary tract
infections in patients with a nephrostomy catheter or dilatation at t
he site of treatment. Conclusion: We conclude that in patients with ur
ine proven sterile prior to ESWL there is no need for antibiotic proph
ylaxis.