Administering antibiotic-loaded irrigation fluid as an alternative for prophylactic intravenous antibiotics in transurethral ureterolithotripsy (TUL): a randomized controlled trial.

Abstract

Prophylactic antibiotics are commonly used to prevent infections and complications during surgeries. In this study inflammatory responses and infectious complications after utilizing antibiotic-loaded irrigation compared with intravenous (IV) prophylactic antibiotics. Eighty-eight participants with ureteral stones enrolled in this prospective randomized controlled trial. Participants were allocated into two groups, namely "standard" with 45 participants, and "antibiotic-loaded" with 43 participants. The "standard" group received standard normal saline irrigation with 1 gram of IV ceftriaxone 30 minutes before in transurethral ureterolithotripsy (TUL), while the "antibiotic-loaded" group received ceftriaxone-added irrigation fluid and did not receive any IV antibiotics. The laboratory tests, including Complete Blood Count (CBC), Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), venous blood gas (VBG), IL-6, creatinine, sodium, potassium, SIRS score, and urine culture were recorded. The continuous variables are described using either mean (standard deviation (SD)) or median (interquartile range (IQR)) and the t-test and Mann-Whitney test are used to infer them. The discrete variables are reported as numbers (percentages) and the Chi-squared test is applied to them. Statistical analyses were performed by the SPSS software (V.26, IBM) with a considering significance criterion of 0.05. Statistically differences were not found in postoperative inflammatory and infectious complications among the two groups (P>0.05) including SIRS score (P=0.385), WBC (P=0.589), IL-6 (P=0.365), ESR (P=0.171), CRP (P=0.279), Platelet (P=0.501), positive urine culture (P=0.922), and post-operative fever (P=0.162). Administering antibiotic-loaded irrigation fluid was as safe and effective as IV ceftriaxone in TUL and could be a reasonable alternative for IV antibiotics.