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Keywords:

  • JJ stent;
  • antibiotic prophylaxis;
  • stent-related symptoms;
  • urinary tract infection

What's known on the subject? and What does the study add?

  • For urinary tract infection (UTI) rates the concept of a peri-interventional antibiotic prophylaxis during endoscopic JJ stent implantation is known to be better than no antibiotic coverage and is therefore recommended by the European Association of Urology. However, there is a lack of evidence concerning the exact antibiotic strategy for the entire stent-indwelling time. In clinical routine, it is an applied practice among urologists to continue antibiotic treatment in a low-dose fashion, even after previous uncomplicated implantations. The intention is to lower the rates of UTIs and to achieve a positive effect on stent-related symptoms (SRSs). This practice is supported by controversial recommendations from sparse publications. However, there exists neither evidence for the benefit, nor for the potential disadvantages of such empiric prevention. Moreover, increasing rates of bacterial drug resistances, growing overall healthcare costs and drug side-effects require a critical antibiotic prescription policy.
  • We analysed UTI and SRS rates in patients given a peri-interventional antibiotic prophylaxis only vs a continuous low-dose antibiotic treatment for the entire stent-indwelling time and showed that the continuous antibiotic low-dose treatment did not reduce the quantity or severity of UTIs and had no effect on SRSs, but involves undesirable disadvantages, e.g. increased drug side-effects and higher rates of resistant bacterial strains, and should therefore be avoided.

Objective

  • To evaluate the antibiotic treatment regime in patients with indwelling JJ stents, the benefits and disadvantages of a peri-interventional antibiotic prophylaxis were compared with those of a continuous low-dose antibiotic treatment in a prospective randomised trial.

Patients and Methods

  • In all, 95 patients were randomised to either receive peri-interventional antibiotic prophylaxis during stent insertion only (group A, 44 patients) or to additionally receive a continuous low-dose antibiotic treatment until stent removal (group B, 51).
  • Evaluations for urinary tract infections (UTI), stent-related symptoms (SRSs) and drug side-effects were performed before stent insertion and consecutively after 1, 2 and 4 weeks and/or at stent withdrawal.
  • All patients received a peri-interventional antibiotic prophylaxis with 1.2 g amoxicillin/clavulanic acid. Amoxicillin/clavulanic acid (625 mg) once daily was administered for continuous low-dose treatment (group B).
  • Primary endpoints were the overall rates of UTIs and SRSs. Secondary endpoints were the rates and severity of drug side-effects.

Results

  • Neither the overall UTI rates (group A: 9% vs group B: 10%), nor the rates of febrile UTIs (group A: 7% vs group B: 6%) were different between the groups.
  • Similarly, SRS rates did not differ (group A: 98% vs group B: 96%).
  • Antibiotic side-effect symptoms were to be increased in patients treated with low-dose antibiotics.

Conclusion

  • A continuous antibiotic low-dose treatment during the entire JJ stent-indwelling time does not reduce the quantity or severity of UTIs and has no effect on SRSs either compared with a peri-interventional antibiotic prophylaxis only.