Confirmation of negative urine culture status after appropriate antibiotic treatment prior to endourological stone procedures: Is it really necessary?

doi:10.21203/rs.3.rs-3346019/v1

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Confirmation of negative urine culture status after appropriate antibiotic treatment prior to endourological stone procedures: Is it really necessary?

https://doi.org/10.21203/rs.3.rs-3346019/v1

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published 08 Feb, 2024

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To evaluate the necessity of confirmation for a negative urine culture test outcome after an appropriate antibiotic regimen for urinary tract infection (UTI) prior to endoscopic stone removal procedures.

170 cases with culture proven UTI and undergoing an appropriate antibiotic regimen based on test outcomes before endoscopic stone removal were evaluated in two groups: Group 1 (n = 85) Patients receiving culture based antibiotic therapy and had a second urine culture test for “sterile urine” status prior to the procedures and Group 2 (n = 85) Patients receiving the same antibiotic therapy and had no additional urine culture test further. Cases were comparatively evaluated with respect to the statistical significance of postoperative infective complications (fever, sepsis) and the duration of hospital stay and re-admission rates during early post-operative period.

Our findings showed that no significant difference was present regarding the rate of infective complications (presence of fever, incidence of septic findings), hospitalization period and readmission rates between two groups. Although the presence of a sterile urine has been confirmed by urine culture test in group 1 cases, no additional urine culture was performed with this aim in group 2 cases ( sterile urine was confirmed with only urinalysis) and the outcomes regarding the infective problems were found to be similiar.

Our current findings indicate that a second urine culture test may not be a “ must” if the patients receive an appropriate antibiotic regimen based on the sensitivity test outcomes for a reasonable time period.

Urine culture test

flexible ureteroscopi

·sterile urine

urinary tract infection

post-operative infective complication

As an endemic disease in some parts of the world, urolithiasis is an important healthcare problem in the world based on its recurrent nature [1]. Regarding the management principles, with the help of marked advances in instrument technology and new treatment concepts, most stones are managed with minimal invasive treatment options. Currently extracorporeal shockwave lithotripsy (SWL); flexible ureteroscopy (fURS) and percutaneous nephrolithotomy (PCNL) with this aim [2, 3].

Of these alternatives, fURS is the preferred modality for both ureteric and renal stones < 2 cm. As a safe and less invasive method than PCNL, fURS is associated with minor complications varying from of 9–25% [4, 5] and limited major complications (< 1%)[6]. Among these complications the infective ones are the most crucial ones where postoperative fever occurs in 7.1%, UTI in 8.1% and sepsis in 5.4% of the cases managed [7–10]. On the other hand, PCNL is the preffered treatment modality in the removal of large (> 2 cm) stones at one session. However, despite its successful outcomes with overall stone free rates of 75–98%, PCNL is regarded as a really invasive approach which could be associated with some certain sever complications (bleeding, perforation and sepsis) [2, 6].Regarding the complication profile of these two procedures infective complications are being regarded as the most crucial ones which should be kept in mind [2].Evaluation of the published data for infective complications of these two modalities, demontrates that while fURS could be associated with such problems in 0.95–8.1% of the cases[9–12] these values have been reported to be 0.9–16.7 after PCNL [7–15].

Thus, a well planned, rational decision making along with a thorough urine examination seem to be the most crucial factors for safe and successful outcomes. To limit or even prevent such infective complications which may sometimes cause death, every patient should be well evaluated for the presence and severity of UTI. In case of a documented infection based on mid-stream urine culture and sensitivity test, UTI should inevitably be treated to render the patient infection free prior to such procedures. The presence of leucocytes and/or nitrite in urinalysis will be regarded as reliable indicators for UTI. European Association of Urology (EAU) guidelines recommend to perform a urinary microscopy and/or obtaining a urine culture test before stone removal for an effective antibiotic management [5]. However, both EAU and American Urological Association (AUA) guidelines acknowledge that their recommendations for antibiotic prophylaxis are based on limited evidence regarding the choice of antimicrobial agents, dose, timing, and duration of procedure [5, 6, 10].

On the other hand, with respect to the treatment of UTI before such procedures, although no distinct data has been reported to date to emphasize the necessity of a perioperative antibiotic prophylaxis for fURS, the EAU guidelines recommends prophylactic antibiotic administration to every all procedures except simple diagnostic URS and distal ureteral stone treatment [16, 17]. For the PCNL procedure in their original trial Gravas et al. were able to show that a perioperative antibiotic prophylaxis could reduce the rate of post-operative complications even for patients with a negative baseline urine culture[18]. In case of a preoperative sterile urine culture status, a single-dose administration has been considered to be sufficient [19]. However, EAU guidelines state that, few studies could be derived from published literature defining the risk of infection following fURS and PCNL existing with no clear-cut evidence.

Thus, a careful evaluation of all cases with respect to the presence of UTI and an appropriate management before endoscopic procedures with agents based culture sensitivity test outcomes seems to be highly critical. With this rational approach the likelihood of post-operative infection could be limited or even eliminated to a certain extent. A systematic review demonstrated that performance of a urine culture/ sensitivity test is superior to urine analysis in ruling out bacteriuria and should therefore be the reference standard [20]. However, although this approach is being recommended by EAU guidelines, it is not fully outlined whether there is any need for an additional urine culture test to confirm the presence of sterile urine after completion of antibiotic regimen before proceeding with stone removal procedure.

In other words there is an ongoing debate if second urine culture test procedure is mandatory following a sensitivity based antibiotic treatment for a maximum period of 10 days before any stone removal procedure. Elimination of second urine culture test may simplify the preoperative diagnostic procedures, shorten the preparative phase and lower the laboratory workload and costs. To the best of our knowledge, this is the first study which will in turn outline the necessity of a second culture test to confirm the urine sterility after antibiotic management. This will let the endourologist to perform the procedure and remove the stones without any delay and also let the patient to undergo the procedure without having further stress during this period with a well preserved quality of life.

We aimed to evaluate the role and necessity of confirmation for a “negative urine culture test outcome” after an appropriate antibiotic regimen prior to endoscopic stone removal procedures in cases presenting with culture positive urinary tract infection.

The multicentric study protocol was approved by Hospital ethical commitee. Files of 5650 patients undergoing fURS and PCNL for kidney stones were retrospectively evaluated between January 2018 and May 2023. Following the elimination of the cases not meeting the inclusion criteria, remaining 170 patients with positive urine culture before the these procedures were included. Patients with bilateral and multiple stones, previous stone related procedures, pregnancy, congenital anomalies and solitary kidneys were all excluded. All cases had calcium containing stones. In addition to the patient demographic data such as gender, age and body mass index (BMI), detailed history, urogenital examination findings, biochemical test outcomes were all recorded. All patients had a urinalysis and urine culture sensitivity test prior to the above mentioned interventions.

fURS was performed by using a single use endoscope (9.0 Fr, HugeMed, China) with the help of ureteral access sheath and Ho-YAG laser under general anesthesia. Standard PCNL procedures were performed with 26 Fr nephroscope (Karl Storz, Tuttlingen, Germany) following percutaneous tract dilatation (Amplatz sheath, Boston Scientific, Natick, MA, USA) until 28–30 Fr. Stones were disintegrated using either Ho-YAG laser unit or an ultrasonic lithotripsy probe (Swiss Lithoclast®, EMS Electro Medical System, Nyon, Switzerland). All procedures were performed by the same experienced surgeons in two centers.

Patients (n:170) were divided into to subgroups as follows: Group 1 (n = 85) Patients with a positive preoperative urine culture test who were operated after appropriate culture sensitivity outcomes based antibiotherapy following the confirmation of sterile urine with a second urine culture test. Group 2 (n = 85) Patients with positive a preoperative urine culture test who were operated after appropriate culture sensitivity outcomes based antibiotherapy and in whom the presence of sterile urine has not been confirmed without performing a second urine culture. Only a complete urinalysis was performed with a Dipstick test (H800 ® and FUS200 ® analytical device (DIRUI, China) in these cases. All cases has a negetive urinalysis test outcomes with negative leukocyte esterase activity and/or nitrite [21].

All patients with a positive preoperative urine culture (significant bacterial growth ≥ 10E5 CFU/ml) received an antibiotic treatment for a maximum of 10 days based on the guidance of antibiotic sensitivity test outcomes with a detailed consultation to the infectious disease department. Additionally all cases received an intraoperative single-shot antibiotic prophylaxis with a third generation cephalosporine. Patients were comparatively evaluated with respect to the presence of infectious complications after these procedures.

Definition of post-operative infective complications

Infectious complications were considered to be present when patients exhibited a fever of > 38°C persisting 48 h [22] and sepsis. Sepsis was defined as the presence of systemic inflammatory response syndrome (SIRS) caused by a suspected infection with 2 or more of the following diagnostic criteria: fever ≥ 38°C or hypothermia ≤ 36.0°C, tachycardia > 90 beats/minute, tachypnea > 20 breaths/minute, change of laboratory values (elevation of C reactive protein CRP value > 2.9mg/dl, leucocytosis > 10.000/µL, leucocytopenia < 4.000/µL and/or thrombocytopenia < 150.000/µl) [23]. Duration of hospital stay and readmission within the first 30 days were also evcaluated between two groups.

Statistical analyses

Statistical analysis was done by using independent-samples t-tests to compare continuous variables, such as stone size and operating time and exact chi-square t-test to compare the categorical variables infectious complications. IBM SPSS Statistics 25 (IBM, Armonk, NY) was used for statistical analysis. The p value was considered significant when p value < 0.05.

Overall a total of 170 patients were included and while fURS was performed in 147 cases; 23 patients underwent PCNL for kidney stones. The microorganism distribution identified in urine culture tests is shown in Fig. 1.

Evaluation of our data obtained in both group of cases revealed following findings;

While the mean patient age in 170 patients (101 men and 69 women) was 43.37 ± 14.28, with a mean BMI value of 26.08 ± 3.40 (Table 1); mean size of the stones was 9.38 ± 3.32 in these cases. The overall stone free rate was 143 (84.1%). Average number of hospitalization days was 3.08 ± 3.35, the number of hospital readmissions was 26 (15.3%). There was no statistically significant difference regarding the patient and stone related factors in both group cases Table 1.

Table 1

Patient demographics and stone characteristic in both groups
			Overall (n = 170)	Group 1 (n = 85)	Group 2 (n = 85)	p
Gender; n (%)	Male		74 (43.5%)62	38 (44.7%)	36(42.4%)	0.61
Gender; n (%)	Female		96 (56.5%) 108	56 (65.9%)	52 (61.2%)	0.61
Age; (years)		Mean ± SD	45.9 ± 13.96	48.04 ± 13.86	43.76 ± 13.81	0.77
BMI; (kg/m2)		Mean ± SD	26.58 ± 4.17	26.99 ± 4.70	26.17 ± 3.54	0.28
Comorbidity status
Hypertension; n (%)			57(33.5%)	34(40.0%)	23(27.1%)	0.07
Diabetes; n (%)			34(20.0%)	21(24.7%)	13 (15.3%)	0.12
Stone size, (mm)		Mean ± SD	16.13 ± 10.98	17.14 ± 12.20	15.20 ± 9.76	0.56
Surgical modality
PCNL; n (%)			23 (13.5%)	12 (14.1%)	11 (12.9%)
fURS; n (%)			147 (86.5%)	67 (45.6%)	80 (54.4%)
SFR in 3rd month; n (%)			143 (84.1%)	73 (85.9%)	70 (82.4%)	0.13
Percutaneous nephrolithotomy (PCNL), Flexible ureteroscopy (fURS), Body mass Index (BMI, Stone free rate (SFR)

With respect to the laboratory evaluation findings, there was no statistically significant difference between two groups on this aspect. While the mean CRP value was 40.48 ± 57.83 in Groıup 1, this value was 38.74 ± 76.04 in Group 2 (p = 0.540). Additionally, mean serum white blood cell count (WBC) evaluation revealed similar outcomes [9.31 ± 3.87 and 9.94 ± 3.57, respectively (p = 0.553)] (Table 2).

Table 2

Comparison of postoperative biochemical parameters of infection in both groups
		Overall (n = 170)	Group 1 (n = 85)	Group 2 (n = 85)	p
Postoperative
CRP	Mean ± SD	39.61 ± 67.36	40.48 ± 57.83	38.74 ± 76.04	0.54
WBC	Mean ± SD	9.62 ± 3.73	9.31 ± 3.87	9.94 ± 3.57	0.55
Seum creatinine level	Mean ± SD	1.09 ± 0.68	1.02 ± 0.51	1.16 ± 0.81	0.29
Serum urea level	Mean ± SD	36.48 ± 22.43	36.83 ± 19.50	36.13 ± 25.14	0.42
C-Reactive protein (CRP), White blood cell (WBC)

In terms of postoperative clinical infective complications; sepsis was diagnosed in 4 cases (4.7%) of Group 1 (2 cases in PCNL group and 2 cases in fURS group) and 2 cases (2.4%) of Group 2 (2 cases in fURS groups) without any significant difference between the two groups (p = 0.41). Similarly post-operative fever rate was similar in both groups without any significance [20 cases in total; 10 cases in Group 1 (11.8%) and 10 cases (11.8%) in Group 2, (p = 1.00) ] (Table 3).

Table 3

Comparison of postoperative clinical parameters of infection in both groups
		Overall (n = 170)	Group 1 (n = 85)	Group 2 (n = 85)	p
Postoperative
Sepsis; n (%)		6(3.5%)	4(4.7%)	2(2.4%)	0.41
Fever; n (%)		20(11.8%)	10(11.8%)	10(11.8%)	1.00
Hospital stay; days	Mean ± SD	3.08 ± 3.35	2.58 ± 3.17	3.29 ± 3.45	0.09
Emergency department readmission; n (%)		26(15.3%)	14(16.5%)	12(14.1%)	0.67

Lastly, both the mean duration of hospitalization (p = 0.095) and emergency department readmission rates (16.5% vs 14.1%, respectively) were similar in both groups without any statistically significant difference (p = 0.670) (Table 3).

Current minimally invasive management options for upper urinary tract stones include URS and PCNL [2, 3]. Although ureteroscopic stone removal procedures are being preferred mainly for medium sized stones (1–2 cm), PCNL is the treatment of choice for the successful treatment of large (> 2 cm) stones. Related with these approaches technological developments and new concepts have expanded the indications for URS with retrograde effective use of flexible scopes/ suction facilities and for PCNL with miniaturization of the equipments used [2, 3]. Although both modalities are being performed in all parts of the world with successful outcomes in experienced hands, they are not completely safe where some possible well-known complications could occur at every step but particularly after these procedures [4–10].

Infection related complications are the most critical issue to be kept in mind prior to these minimal invasive procedures particularly before/during retrograde intrarenal manipulations. Although flexible ureteroscopic renal stone removal has become a vital alternative on this aspect which began to be applied for also larger stones with acceptable stone free rates [3, 4]. Accumulated experience and published data clearly indicate that such complications (which sometimes could be lethal)need to be kept in mind with a very careful/rational treatment plan [8, 9, 11]. Infective problems after retrograde intrarenal stone removal procedures include postoperative fever occurs in 7.1%, UTI in 8.1% and sepsis in 5.4% of the cases managed [7–10]. Additionally such infective complication could be encountered in 0.9–16.7% of the cases after percutaneous stone removal procedures [7–15].

In the light of these facts and the importance of severe infective complications, to prevent such problems which could even be lethal in some cases, a rational and carefulpreoperative diagnostic approach is highly critical [24]. The presence of any urinary tract infection should be well evaluated and excluded prior to such interventions [16, 17, 20]. A systemic review showed, that a urine culture test is superior to simple urine analysis test in ruling out bacteriuria andshould therefore be performed in avery candidate with symptoms of infection prior to endoscopic stone removal procedures [20]. However, a negative urine dipstick test has also been found to be effective and predictive as a screening test with this aim [21].

In other words, it seems to be sufficient obtaining a preoperative urine culture only in case of a positive urine analysisi test regarding the measures to be taken for postoperative infective complications. In accordance to the recommendations of the EAU and the AUA, all patients need to receive an intraoperative single-shot antibiotic prophylaxis [5, 6, 10]; except patients, who already received a sensitivity test-guided pre-operative antibiotic treatment based on a significant bacterial growth (≥ 10E5 CFU/ml) in urine culture. The systemic review and metanalysisof Lo et al. could show, that a prophylactic antibiotictreatment can reduce the incidence of pyuria and bacteriuria following ureterorenoscopic laser lithotripsy, but not the incidence of clinically relevant UTI [16]. On the contrary, Gravas et al. showed, that patients undergoing PCNL without perioperative antibiotic prophylaxis had asignificant higher rate of fever (p = 0.04) and complications within thefirst 30 days (< 0.0001) postoperatively compared to patients with anantibiotic prophylaxis [18].

Thus, a well planned, rational decision making (evaluating the stone and patient related factors) along with a thorough urine examination seem to be the most crucial factors for safe and successful outcomes. In an attempt to limit or prevent such infective complications which may sometimes cause death after such endoscopic stone removal procedures, every candidate patient should be well evaluated for the presence and severity of UTI. Following the performance of a mid-stream urine culture and sensitivity test in case of a documented infection, UTI should inevitably be treated to render the patient infection free prior to such procedures. It is appropriate to obtain a urine culture for every patient where the presence of leucocytes and/or nitrite may be regarded as reliable indicators for a urinary tract infection. Related with this issue, the EAU recommends to perform a urinary microscopy and/or obtaining a urine culture before stone removal interventions for an effective antibiotic management [6]. However, both EAU and AUA guidelines acknowledge that their recommendations for antibiotic prophylaxis are based on limited evidence regarding the choice of antimicrobial agents, dose, timing, and duration of procedure [5, 6, 10].

On the other hand, no distinct data has been reported to date to emphasize the necessity of a perioperative antibiotic prophylaxis for URS and this approach is being recommended by EAU guidelines to every patient undergoing endourological treatment except simple diagnostic URS and distal ureteral stone treatment [16, 17]. Although the necessity and the effectivity of perioperative antibiotic prophylaxis were well evaluated in a limited number of studies so far with varying rate of success and degree of recommendations [18, 19], EAU guidelines state that, few studies could be derived from published literature defining the risk of infection following URS and percutaneous stone removal existing with no clear-cut evidence.

These findings emphasize that a careful evaluation regarding the presence of UTI and an appropriate management based on the culture sensitivity test outcomes seems to be highly critical before such interventions. With this rational approach the likelihood of post-operative infection could be limited to a certain extent in such cases. A systematic review demonstrated that performance of a urine culture/sensitivity test is superior to a simple urinalysis in ruling out any infection and therefore this approach should be the standard in all patients [20]. However, although EAU guidelines recommend this approach; the exact need for an additional urine culture test after completion of antibiotic regimen before planned stone removal procedure to confirm the presence of a sterile urine is not fully outlined with clinical evidence.

Evaluation of our findings showed no statistically significant difference regarding the rate of infective complications ( presence of fever, incidence of septic findings), duration of hospitalization and readmission rates between two group of cases. Although the presence of a sterile urine has been confirmed by urine culture test in group 1 cases, no additional urine culture was performed in group 2 cases (sterile urine was confirmed with only urinalysis) and the outcomes regarding the infective problems were found to be similiar.

In the light of our results and ongoing debate regarding the necessity of performing a second urine culture test following a sensitivity based antibiotic treatment before planned procedures; this approach seems to obtain a challenging status. Based on present our findings, elimination of a second urine culture test could bring the diagnostic procedures in a simplified status by lowering the laboratory workload and limit the overall costs. To the best of our knowledge, this is the first study which will in turn give reliable insights into this ongoing, challenging issue. Morover,this will let the endourologist to perform the procedure without any delay waiting for the result of second culture test (earlier removal of the stone and related problems) and more importantly let the patient have diminished stress with a well preserved quality of life.

Our study is not free of limitations.First of all the retrospective nature of the design is an important one and the number of cases included could be accepted as relatively small. However taking the highly limited data reported so far on this very critical issue into account, we believe that as the first trial focusing on this issue our data will be contributive anough on this aspect.

Our current findings indicating no increased risk of infective complications in cases undergoing endoscopic stone removal procedures following the confirmation of sterile urine with urinalysis only, emphasize well that a second urine culture test may not be a “ must” in these cases if the patients receive an appropriate antibiotic regimen based on the sensitivity test outcomes for a reasonable time period. However we certainly believe that further prospective studies with larger series of cases focusing on this issue are certianly needed to support our findings.

Author contributions KS: project development and manuscript writing. CS: project development and manuscript. RS: data collection and manuscript writing. AA: data collection. EMS: data collection. SY: data collection. KK: data collection.

Compliance with ethical standards

Conflict of interest The authors have no confict of interest to declare.

Ethical approval This retrospective study was conducted after receiv‑ ing approval from the institutional review board.

Informed consent All the participants have given informed consent before inclusion in the present study

Curhan GC (2007) Epidemiology of stone disease. Urol Clin North Am. 34:287 – 93. https://doi:10.1016/j.ucl.2007.04.003.
de la Rosette J, Denstedt J, Geavlete P, Keeley F, Matsuda T, Pearl M, Preminger G, Traxer O, CROES URS Study Group (2014) The clinical research office of the endourological society ureteroscopy global study: indications, complications, andoutcomes in 11,885 patients. J. Endourol. 28 (2), 131–139. https://doi.org/10.1089/end.2013.0436.
Srisubat A, Potisat S, Lojanapiwat B, Setthawong V, Laopaiboon M (2014) Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst Rev. CD007044. https://doi:10.1002/14651858.CD007044.pub3.
Hyams ES, Monga M, Pearle MS et al (2015) A prospective, multi-institutional study of flexible ureteroscopy for proximal ureteral stones smaller than 2 cm. J Urol.; 193: 165–169.
Turk C, Knoll T, Petrik A, et al. Urolithiasis, 2016; Guideline / European Association of Urology. URL: http://uroweb.org/guideline/urolithiasis/
Preminger, G.M., Tiselius, H.-G., Assimos, D.G., Alken, P., Buck, C., Gallucci, M., Knoll, T.,Lingeman, JE, Nakada SY, Pearle MS, Sarica K, Turk C, Wolf JS (2007) EAU/AUA Nephrolithiasis Guideline Panel, 2007 guideline for the management of ureteral calculi. J. Urol. 178 (6), 2418–2434. https://doi.org/10.1016/j.juro.2007.09.107.
Somani BK, Giusti G, Sun Y, Osther PJ, Frank M, De Sio M, Turna B, de la Rosette J (2017) Complications associated with ureterorenoscopy (URS) related to treatment of urolithiasis: the clinical research Office of Endourological Society URS global study. World orld J Urol. 35(4):675–681. https://doi:10.1007/s00345-016-1909-0.
Jiahua Pan, Qi Chen, Wei Xue, Yonghui Chen, Lei Xia, Haige Chen, Yiran Huang (2013) RIRS versus mPCNL for single renal stone of 2–3 cm: clinical outcome and cost-effective analysis in Chinese medical setting. Urolithiasis 41:73–78. https://doi:10.1007/s00240-012-0533-8
Blackmur JP, Maitra NU, Marri RR, Housami F, Malki M, Mcllhenny C (2016) Analysis of factors’ association with risk of postoperative urosepsis in patients undergoing ureteroscopy for treatment of stone disease. J Endourol. 30:963–969. https://doi:10.1089/end.2016.0300.
Skolarikos and de la Rosette (2008) have reported that the frequency of major complications after PCNL was 0.9–4.7% for septicemia Skolarikos A, de la Rosette J. Prevention and treatment of complications following percutaneous nephrolithotomy. Curr Opin Urol. 18:229–234. https://doi:10.1097/MOU.0b013e3282f46afc.
Fan S, Gong B, Hao Z, Zhang L, Zhou J, Zhang Y, Liang C (2015) Risk factors of infectious complications following fexible ureteroscope with a holmium laser: a retrospective study. Int J Clin Exp Med 8:11252–11259. ISSN:1940–5901/IJCEM0008165
Zhong W, Leto G, Wang L, Zeng G (2015) Systemic infammatory response syndrome after fexible ureteroscopic lithotripsy: a study of risk factors. J Endourol 29:25–28. https://doi:10.1089/end.2014.0409.
Korets R, Graversen JA, Kates M, Mues AC, Gupta M (2011) Post-percutaneous nephrolithotomy systemic infammatory response: a prospective analysis of preoperative urine, renal pelvic urine and stone cultures. J Urol 186:1899–1903. https://doi:10.1016/j.juro.2011.06.064.
Draga RO, Kok ET, Sorel MR, Bosch RJ, Lock TM (2009) Percutaneous nephrolithotomy: factors associated with fever after first postoperative day and systemic infammatory response syndrome. J Endourol 23:921–927. https://doi:10.1089/end.2009.0041.
Erdil T, Bostanci Y, Ozden E, Atac F, Yakupoglu YK, Yilmaz AF, Sarikaya S (2013) Risk factors for systemic infammatory response syndrome following percutaneous nephrolithotomy. Urolithiasis 41:395–401. https://doi:10.1007/s00240-013-0570-y.
Lo CW, Yang SS-D, Hsieh C-H, Chang S-J (2015) Effectiveness of prophylactic antibiotics against post-ureteroscopic lithotripsy infections: systematic review andmeta-analysis. Surg. Infect. 16 (4), 415–420. https://doi.org/10.1089/sur.2014.013.
Hein C, Pilatz A, Wagenlehner, FME (2017) Sinnvolle Antibiotika prophylaxe in der Urologie: Vermeidung von zunehmender Resistenzent wicklung. Der Urol. 56 (9),1109–1115. https://doi.org/10.1007/s00120-017-0433-1.
Gravas S, Montanari E, Geavlete P, Onal B, Skolarikos A, Pearle M, Sun YH, de la Rosette J (2012) Postoperative infection rates in low risk patients undergoing percutaneous nephrolithotomy with and without antibiotic prophylaxis: A matched casecontrol study. J. Urol. 188 (3), 843–847. https://doi.org/10.1016/j.juro.2012.05.007.
Chew BH, Flannigan R, Kurtz M, Gershman B, Arsovska O, Paterson RF, Eisner BH, Lange D (2016) A single dose of intraoperative antibiotics is sufficient to prevent urinary tract infection during ureteroscopy. J. Endourol. 30 (1), 63 68. https://doi.org/10.1089/end.2015.0511.
Bonkat G, Braissant O, Cai T, Koves B, Bjerklund Johansen TE, Pickard R, Veeratterapillay R (2017) Non-molecular methods to detect bacteriuria prior to urological interventions: A diagnostic accuracy systematic review. Eur. Urol. Focus 3(6), 535–537. https://doi.org/10.1016/j.euf.2018.03.004.
Lammers RL, Gibson S, Kovacs D, Sears W, Strachan G (2001) Comparison of test characteristics of urine dipstick and urinalysis at various test cutoff points. Ann. Emerg. Med. 38 (5), 505–512. https://doi.org/10.1067/mem.2001.119427.
Naomi PO, Barie PS, Bartlett TB, Bleck T, Garvey G, Jacobi J, Linden P, Maki DG, Nam M, Pasculle W, Pasquale MD, Tribett DL and Masur H (1998) Practice guidelines for evaluating new fever in critically ill adult patients. Clin Infect Dis; 26: 1042–1059. https://doi:10.1086/520308.
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL and Ramsay G (2001) International Sepsis Definitions Conference. SCCM/ESICM/ACCP/ATS/ SIS International Sepsis Definitions Conference. Intensive Care Med 2003; 29: 530–538. https://doi:10.1007/s00134-003-1662-x.
Wollin DA, Joyce AD, Gupta M, Wong MYC, Laguna P, Gravas S, Gutierrez J, Cormio L, Wang K, Preminger G M(2017) Antibiotic use and the prevention and management of infectious complications in stone disease. World J. Urol. 35 (9),1369–1379. https://doi.org/10.1007/s00345-017-2005-9.

No competing interests reported.

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Confirmation of negative urine culture status after appropriate antibiotic treatment prior to endourological stone procedures: Is it really necessary?

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