Complicaciones infecciosas en pacientes con urocultivo negativo, que reciben o no profilaxis antibiótica extendida, llevados a ureterolitotomía endoscópica flexible en el Hospital Universitario Mayor
Thesis
Introduction: The antibiotic prophylaxis protocol is varied in patients with a negative urine culture who undergo flexible endoscopic laser ureterolithotomy, management guidelines include extended prophylactic management (72 hours prior to the procedure) or a dose of pre-surgical prophylaxis (standard prophylaxis). The use of prophylactic antibiotics reduces the risk of urinary tract infection, sepsis, and bacteremia; however, it must be done without generating induction of multiresistant bacteria. Methodology: Retrospective, observational, analytical cohort study, infections were compared in patients with negative urine culture between the cohorts: extended antibiotic prophylaxis vs. standard prophylaxis, taken to ULEF. Results: 10.3% of patients presented complications, 7.2% of patients with postoperative urinary infection, 1.8% had upper urinary tract infection and 1.4% had sepsis of urinary origin. Lower urinary tract infections were significantly more likely in the extended prophylaxis group with 6.8% versus 2.7% (RR= 2.8; 95% CI: 1.10-7.37, p=0.030). The risk of upper urinary tract infection and sepsis did not show significant differences. 69% of patients with postoperative infection had blood cultures with multiresistant germs, this risk was higher in patients with extended prophylaxis (RR= 3.1; 95% CI: 1.33-7.59, p=0.009). Conclusions In patients with negative urine culture who underwent ULEF, the risk of lower urinary tract infection is approximately 2 times higher than in patients with standard prophylaxis, without showing differences in the incidence of upper urinary tract infection or sepsis. The risk of multiresistant germs in postoperative isolation is twice as high in the extended prophylaxis group. Therefore, we recommend standard prophylaxis 60 minutes before surgery.
