Intrarenal Antibiotic Irrigation During Percutaneous Nephrolithotomy Reduces Postoperative Infections and Eliminates Sepsis in High-Risk Patients: A Matched Cohort Study
Pengbo Jiang, Bruce M. Gao, Harel C. Sims, Kriselle Madamba, Kyle A. Bociort, Seyedamirvala Saadat, Elliott Freudenburg, Gustavo Gryzinski, Aymon Ali, Ryan Hsi, Roshan M. Patel, Jaime Landman, Ralph V. ClaymanPurpose:
To evaluate whether intrarenal antibiotic-augmented irrigation with neomycin/polymyxin B during percutaneous nephrolithotomy (PCNL) in patients at high risk for infection was associated with lower postoperative infectious complications and reduced infection-related resource utilization.
Materials and Methods:
We performed a single-center, retrospective matched cohort study of adults undergoing PCNL who were at high risk for infection between January 2020 and December 2024. Fifty patients who received intrarenal neomycin/polymyxin B irrigation (1 mL GU irrigant per 3-L saline bag) were matched 1:1 to controls receiving standard saline irrigation by age, sex, diabetes, Charlson Comorbidity Index, and preoperative urinary drainage. The primary end-point was symptomatic urinary tract infection (UTI) within 30 days. Secondary outcomes included systemic inflammatory response syndrome (SIRS), sepsis during index hospitalization, infection-related prolonged hospitalization, emergency department visits for infection, and 30-day infection-related readmission.
Results:
Thirty-day UTI occurred in 3/50 patients (6.0%) in the GU group
Conclusions:
In this matched cohort of PCNL patients at high risk for infection, intrarenal neomycin/polymyxin B irrigation was associated with substantially lower postoperative infectious morbidity, including elimination of sepsis during index hospitalization, with comparable short-term renal safety outcomes.