Pcnl Postoperative Infection Related Factors Of Preoperative Use Of Antibiotics, Systematic Reviews

[Objective] To evaluate the preoperative and intraoperative factors that might affect development of fever following Minimally invasive percutaneous nephrolithotomy (mPCNL) and to investigate whether antibiotic prophylaxis is significant for mPCNL.To determine the effects of irrigation fluid's absorption on system hemodynamics during mini-percutaneous nephrolithotomy.[Methods] In this study 515 patients with renal calculus or calculus of superior ureter from 2003/01 to 2008/12 were collected.The all underwent mini-percutaneous nephrolithotomy.0.9% NaCl was used as irrigate during operationThe speed of irrigation was less than 200ml/min.Mean arterial blood pressure (MAP) were recorded before and after irrigation and during the operation.And stone analysis was available routinely after the procedure.Postoperative fever was defined as an axillary body temperature of≥38℃,and patients that were febrile were ascribled to group 1,the remainling patients were afebrile (group 2).[Results] The patients with postoperative fever had larger stone burdens and longer operative times and more infectious stones than patients without postoperative fever. There were statistically significantly more febrile patients in group 1 (patients who have infention stones) than there were in group 2 (patients who have non-infention stones),but if define febrile as T≥38.5℃, There were no statistical differences.There were statistically significantly longer infusion time in the febrile patients.As the infusion time increased,the MAP did not increased accordingly.[Conclusion] mPCNL is a effective way in treating renal calculus or calculus of superior ureter.The patients with postoperative fever had larger stone burdens and longer operative times and more infectious stones than patients without postoperative fever.No significant changes were found in hemodynamics ,but some complications might take place if extension of operation time,loss of tunnel,perforation of renal pelvis,renal parenchyma and ureter exist during mini-percutaneous nephrolithotomy.Hemodynamics was very important to discover irrigation fluid absorption syndrome in time.The number of patients with postoperative fever increased as the operative time.We need more evidence to evaluate the effectiveness of prophylactic antibiotics in men with preoperatively sterile urine undergoing PCNL [Objective] To determine whether antibiotic prophylaxis can reduce the risk of post-operative infective complications in men undergoing PCNL who had sterile pre-operative urine.[Methods] MEDLINE,EMBASE,Cochrone Collaboration Reviews,Chinese Medical Current Contents(CMCC),and National Knowledge Infrastructure (CNKI) were searched for randomized controlled trials that compared the effect of antibiotic prophylaxis with placebo or active controls for men undergoing PCNL with preoperative sterile urine.Two reviewers independently extracted the data of patient characteristics and outcomes based on a prospectively developed protocol.[Results] A total of 5 trials involving 618 patients met the inclusion criteria.Prophylactic antibiotic use in patients at low risk undergoing PCNL significantly decreased bacteriuria and fever incidence.The relative risk for post-PCNL bacteriuria and post-PCNL fever were 0.47 (95% CI 0.35 to 0.63) and 0.65(95% CI 0.45 to 0.92).Effective antibiotic classes included cefotaxime 0.33 (95% CI 0.13 to 0.86),norfloxacin 0.25 (95% CI 0.03 to 2.13),levofloxacin 0.15 (95% CI 0.02 to 1.14).Treatment protocols of any duration were effective.[Conclusions] Meta-analysis shows:(1)Antibiotic prophylaxis obviously decreases the incidence of bacteriuria and fever but not bacteremia in men with preoperative sterile urine undergoing PCNL.(2)Many common classes of antibiotics are effective and safety, agent choice must be made according to the cost,convenience,patient allergies,local antibiotic sensitivity test and potential risk for future development of antibiotic resistance.(3)Future RCTs should compare different types and dosing regimens of antibiotics for patients undergoing PCNL.The cost-effectiveness and long-term adverse effects of antibiotic prophylaxis should also be concluded.