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Amikacin as the Most Potent Antibiotic Locally, is it Required Prior to Extracorporeal Shock Wave Lithotripsy (ESWL) in Patients with Double J Stents?

Mohammed Abdulla Mohammed Ebrahim Rafie, Ziad Alnaib, Zeyad Aljuboori and Elsawi Osman

Objective: To assess the efficacy of Amikacin as the anti-biotic of least recorded resistance locally in preventing urinary infective episodes following ESWL (Extracorporeal Shock Wave Lithotripsy) in patients with DJ stents in-situ.

Materials and methods: A retrospective review of a cohort of 60 adult patients with upper urinary tract calculi and DJ stent in-situ, who received one dose of Amikacin intravenously immediately before ESWL was carried out. All patients had a documented negative urine culture prior to ESWL. The incidence rate of post ESWL bacteriuria was calculated and compared to the published incidence rates of bacteruria patients who did not receive any prophylaxis.

Results: A total number of 60 adult patients with DJ stent in-situ, who received Amikacin prophylaxis, underwent ESWL between the 1st of January 2017 and the 31^st of December 2017. All of the 60 patients had a documented negative urine culture pre-ESL. Two patients were found to have positive urine culture post ESWL with an incidence rate of 3.33. This was not statistically different to the published percentage of patients who received no prophylaxis in the compared studies that showed incidence rates of 3.08 and 2.17 respectively (Chi-square=0.704, p=0.703).

Conclusion: Intravenous Amikacin prophylaxis was not efficacious in reducing UTI and urinary sepsis following ESWL in patients with DJ stents in-situ, despite being the antibiotic of least resistance locally.