Perioperative Prophylaxis of Upper Urinary Tract Infections in Percutaneous Nephrolithiasis Surgery

The objective: to compare the effectiveness and safety of using fosfomycin trometamol in perioperative prophylaxis with other standard antibiotics in patients performing mini percutaneous nephrolithotripsy (mPNL). Materials and methods. The study was conducted in the period from May 2020 to May 2023 in the urology department of the Kyiv Clinical Regional Hospital (base of the Department of Urology of the P. L. Shupyk National Institute of Health of Ukraine). The study inclusion criteria were patients with renal or proximal ureteral calculi with indications for mPNL, with a total size of renal calculi from 1.0 to 4.0 cm. Two hundred patients were randomly divided into 2 groups, depending on the drug taken for perioperative prophylaxis. 95 patients took fosfomycin trometamol (group A), while the other 105 patients took the second-generation cephalosporin cefuroxime (control group B). Patients in the fosfomycin group took a single oral dose of 3,0 g, which was taken 12 hours before mPNL. Control group B took a dose of 1.5 g of cefuroxime intravenously 12 hours before surgery. An analysis of the frequency of infectious complications and side effects between the two groups, as well as the postoperative length of stay in the hospital, was conducted. Results. Postoperative infection complications were observed in 15 patients of both groups, which was 7.5% of all 200 studied patients: 3.2% (n=3) in the group А and 11.4% (n=12) in the group В (p<0,05). Lower rates of postoperative fever were observed in the fosfomycin group - 2.1% versus 9.5% in the cefuroxime group (p<0,05) with an increase in the ratio of preoperative and postoperative leukocytes (more than 1.5) in the fosfomycin group in 3.2% of patients versus 10.5% in the cefuroxime group (p<0,05) and an increase of C-reactive protein in the fosfomycin group 45±15 mg/l versus 165±45 mg/l, respectively (p<0.0001). In patients in the fosfomycin group with nephrostomy drainage, itwas removed on the next postoperative day in 75 (97,7%) vs 72 (87,8%) patients in the control group (p<0,05). There were statistical differences between the groups in terms of the average length of stay in the hospital – 1.9 in the fosfomycin group versus 2.3 days in control group (p<0,05); and the mean time of ureteral stent removal after the procedure was 10.5±3.5 days in the fosfomycin group and 14.5±4.5 days in the control group (p<0,05). Conclusions. One preoperative oral dose of 3,0 g of fosfomycin trometamol in combination with standard perioperative infection prophylaxis in percutaneous surgery of upper urinary tract stones showed good efficacy and safety with reducing of average length of hospitalization of patients. Fosfomycin tromethamol can be used as a mainstream option for therapeutic and prophylactic purposes in the treatment of urinary tract infections, which will help prevent further increases in resistance to commonly used antibiotics. However, further research is needed to draw definitive conclusions and recommendations.