Role of Pre-Operative Single Dose Versus Double Dose Antibiotic in Prevention of UTI in Patients Undergoing Ureteroscopy with Negative Urine Culture: Pre-Operative Dose Antibiotic: UTI in Ureteroscopy with Negative Urine Culture

Manisha Ramchand; Arif Ali; Naresh Kumar Valecha; Ayesha Khan; Abdul Mujeeb; Hassan Siddiqui; Farooque Ahmed

doi:10.54393/pjhs.v7i6.3708

Authors

Manisha Ramchand Department of Urological Surgery and Transplantation, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
Arif Ali Department of Urological Surgery and Transplantation, Jinnah Sindh Medical University, Karachi, Pakistan
Naresh Kumar Valecha Department of Urological Surgery and Transplantation, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
Ayesha Khan Department of Urological Surgery and Transplantation, Jinnah Sindh Medical University, Karachi, Pakistan
Abdul Mujeeb Department of Urological Surgery and Transplantation, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
Hassan Siddiqui Department of Urological Surgery and Transplantation, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
Farooque Ahmed Department of Urology, New Mowasat Hospital, Salmiya, Kuwait

DOI:

https://doi.org/10.54393/pjhs.v7i6.3708

Keywords:

Ureteroscopy, Urinary Tract Infections, Urolithiasis, Antibiotic Prophylaxis, Ureteral Stents

Abstract

Ureteroscopy (URS) is a minimally invasive procedure for ureteral stones, strictures, and tumors. Though generally safe, it carries a risk of postoperative urinary tract infections (UTIs), particularly with instrumentation or residual fragments. The optimal prophylactic antibiotic strategy remains debated. Objectives: To compare single- versus double-dose intravenous Ceftriaxone for preventing post-URS UTIs in patients with sterile preoperative urine. Methods: A prospective cohort study was conducted from 12 June to 11 December 2025, including 86 patients aged 18–60 years undergoing URS for ureteric calculi (0.5–2.0 cm) with negative urine cultures. Patients were allocated to two equal groups: Group A received a single 2 g intravenous Ceftriaxone dose at anesthesia induction, and Group B received two doses, 24 hours preoperatively and at induction. Exclusion criteria included uncontrolled diabetes or hypertension, positive culture, and cephalosporin allergy. Data were collected by a standardized proforma. Postoperative UTI was defined clinically (fever >100°F, TLC >10×10⁹/L, pulse >100/min) and confirmed by urine culture. Statistical analysis was performed using SPSS version 22.0; p<0.05 was considered significant. Results: Baseline characteristics (age, BMI, gender) were comparable between groups (p>0.05). UTIs occurred in 11 patients (12.8%), with no significant difference between Group A (16.3%) and Group B (13.9%) (p=0.74). Isolated organisms included E. coli, Enterococcus faecalis, Proteus mirabilis, and Enterobacter. No significant associations were found with stone location, URS side, stenting, or diabetes. Conclusions: Single- and double-dose Ceftriaxone equally prevent post-ureteroscopy UTIs in sterile urine patients. Single-dose is a cost-effective, stewardship-friendly option. Further trials needed.

References

Li Z, Tang X, Wu S, Liu S, Wang X, He Z et al. Efficacy and Safety of Semirigid Ureteroscopy Combined with Holmium: Yttrium-Aluminum-Garnet Laser Lithotripsy for the Treatment of Proximal Ureteral Calculi: A Single-Arm Meta-Analysis. European Urology Open Science. 2024 Dec; 70: 124-34. doi: 10.1016/j.euros.2024.10.006.

McClinton S, Starr K, Thomas R, MacLennan G, Lam T, Hernandez R et al. The Clinical and Cost Effectiveness of Surgical Interventions for Stones in the Lower Pole of the Kidney: The Percutaneous Nephrolithotomy, Flexible Ureterorenoscopy and Extracorporeal Shockwave Lithotripsy for Lower Pole Kidney Stones Randomized Controlled Trial (Pure RCT) Protocol. Trials. 2020 Jun; 21(1): 479. doi: 10.1186/s13063-020-04326-x.

Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M et al. EAU Guidelines on Interventional Treatment for Urolithiasis. European Urology. 2016 Mar; 69(3): 475-82. doi: 10.1016/j.eururo.2015.07.041.

Scotland KB and Lange D. Prevention and Management of Urosepsis Triggered by Ureteroscopy. Research and Reports in Urology. 2018 Jul: 43-9. doi: 10.2147/RRU.S128071.

Bhojani N, Miller LE, Bhattacharyya S, Cutone B, Chew BH. Risk Factors for Urosepsis After Ureteroscopy for Stone Disease: A Systematic Review with Meta-Analysis. Journal of Endourology. 2021 Jul; 35(7): 991-1000. doi: 10.1089/end.2020.1133.

Ivan SJ and Sindhwani P. Comparison of Guideline Recommendations for Antimicrobial Prophylaxis in Urologic Procedures: Variability, Lack of Consensus, and Contradictions. International Urology and Nephrology. 2018 Nov; 50(11): 1923-37. doi: 10.1007/s11255-018-1971-1.

Hsieh CH, Yang SS, Lin CD, Chang SJ. Are Prophylactic Antibiotics Necessary in Patients with Preoperative Sterile Urine Undergoing Ureterorenoscopic Lithotripsy? British Journal of Urology International. 2014 Feb; 113(2): 275-80. doi: 10.1111/bju.12502.

El-Agamy ES, Elhelaly MA, Abouelgreed TA, Abdrabuh AM, Elebiary MF, Elatreisy A et al. Randomized Comparison of the Effect of Standard Antibiotic Prophylaxis Versus Enhanced Prophylactic Measures on the Rate of Urinary Tract Infection After Flexible Ureteroscopy. Archivio Italiano di Urologia e Andrologia. 2023 Mar; 95(1): 11084. doi: 10.4081/aiua.2023.11084.

Lightner DJ, Wymer K, Sanchez J, Kavoussi L. Best Practice Statement on Urologic Procedures and Antimicrobial Prophylaxis. The Journal of Urology. 2020 Feb; 203(2): 351-6. doi: 10.1097/JU.0000000000000509.

Sui W, Yang H, Pepic L, Chang K, Shee K, Rompsaithong U et al. Longer Preoperative Antibiotic Duration Before High-Risk Ureteroscopy Does Not Decrease Infectious Complications. Journal of Endourology. 2025 Jan; 39(1): 34-41. doi: 10.1089/end.2024.0487.

Shaikh AA, Chand K, Soomro MI, Pirzado AG, Shaikh NA, Abassi A. Urinary Tract Infection in Patients with Ureteric Stone, Before and After Ureteroscopy. Rawal Medical Journal. 2023 Sep; 48(3): 722-.

Veeratterapillay R, Gravestock P, Harding C, Shaw M, Fitzpatrick J, Keltie K et al. Infection After Ureteroscopy for Ureteric Stones: Analysis of 71,305 Cases in the Hospital Episode Statistics Database. British Journal of Urology International. 2023 Jan; 131(1): 109-15. doi: 10.1111/bju.15850.

Girgin R and Demirkiran ED. Postoperative Fever and Systemic Inflammatory Response Syndrome after Ureteroscopy for Stone Disease in the Geriatric Population: Risk Factors and Determinants. Journal of Urological Surgery. 2020 Aug; 7(3):177-183. doi: 10.4274/jus.galenos.2020.3366.

Ozgur BC, Ekıcı M, Yuceturk CN, Bayrak O. Bacterial Colonization of Double J Stents and Bacteriuria Frequency. The Kaohsiung Journal of Medical Sciences. 2013 Dec; 29(12): 658-61. doi: 10.1016/j.kjms.2013.01.017.

Shaker EK and Chaloob FA. Risk Factors in Bacterial Colonization of Internal Ureteral Stent. Bionatura. 2021; 6: 2022-6. doi: 10.21931/RB/2021.06.03.22.

Westhoff N, Anokhin A, Patroi P, Neuberger M, Siegel F, Pfalzgraf D. Prospective Evaluation of Antibiotic Management in Ureteral Stent and Nephrostomy Interventions. Urologia Internationalis. 2022 Apr; 106(4): 411-8. doi: 10.1159/000517546.

Samir M, Mahmoud MA, Tawfick A. Does bacterial Colonization Influence Ureteral Stent-Associated Morbidity? A Prospective Study. Arab Journal of Urology. 2023 Jul; 21(3): 156-61. doi: 10.1080/2090598X.2022.2164124.

Cornette J, Lange D, Chew BH, Tailly T. Bridging the Knowledge Gap: Past, Present, and Future of Antibiotic Use for Ureteral Stents. British Journal of Urology International. 2024 Dec; 134(6): 858-68. doi: 10.1111/bju.16515.

Damavand RS, Esmaeili S, Bateni BH, Tavakoli AA, Kazemnezhad E. Comparing the Effect of Peri-Operative Antibiotic Prophylaxis Only with Continuous Low-Dose Antibiotic Treatment on the Incidence of Urinary Tract Infection and Stent-Related Symptoms in Patients Undergoing Double-J (DJ) Stent Insertion Following Transurethral Lithotripsy (TUL). World Journal of Urology. 2023 Nov; 41(11): 3027-32. doi: 10.1007/s00345-023-04585-8.

Chew BH, Flannigan R, Kurtz M, Gershman B, Arsovska O, Paterson RF et al. A Single Dose of Intraoperative Antibiotics Is Sufficient to Prevent Urinary Tract Infection During Ureteroscopy. Journal of Endourology. 2016 Jan; 30(1): 63-8. doi: 10.1089/end.2015.0511.

Rosen GH, Wright CC, Murray KS. Antibiotic Stewardship in Urological Procedures: Are Prophylactic Recommendations Appropriate? American Urological Association. 2023.

Asmarawati TP, Djojodimedjo T, Andhika DP, Rusli M, Qibtiyah M, Mahdi BA et al. The Use of Antibiotic Prophylaxis in Patients Undergoing Urologic Procedures in an Academic Hospital Surabaya: A Retrospective Study. Journal of Infection in Developing Countries. 2023; 17(6): 874-880. doi: 10.3855/jidc.17180.