One-Day Aminoglycosides versus Three-Day Ceftazidime for Perioperative Prophylaxis and Postoperative Sepsis Risk in Patients with Urinary Calculi: A Propensity Score-Matched Retrospective Cohort Analysis.

BACKGROUND

Perioperative antimicrobial prophylaxis reduces infectious complications after urinary stone removal, but the optimal agent to prevent postoperative sepsis remains uncertain amid rising drug-resistant gram-negative bacteria. We compared aminoglycoside prophylaxis versus ceftazidime for prevention of postoperative sepsis.

METHODS

In this retrospective propensity score-matched cohort study, clinical data were retrospectively extracted from the electronic medical record system after completion of routine clinical care. Among 420 matched patients undergoing endourological or percutaneous stone removal (210 receiving ceftazidime prophylaxis and 210 receiving aminoglycoside prophylaxis), propensity score matching was performed using age and baseline white blood cell count, and missing data were handled by multiple imputation. The primary outcome was postoperative sepsis. Multivariable conditional logistic regression was used to evaluate the independent association between prophylactic regimen and postoperative sepsis, with sensitivity analyses using an extended adjustment model and Firth penalized logistic regression.

RESULTS

Postoperative sepsis occurred in 18 of 210 patients receiving ceftazidime and in 21 of 210 patients receiving an aminoglycoside (8.57% vs. 10.00%, P=0.614). Secondary outcomes, including mortality, postoperative antibiotic duration, renal function parameters, and microbiological eradication rates, were similar between groups. After adjustment, prophylactic regimen was not independently associated with postoperative sepsis (aOR: 1.12, 95% CI: 0.56-2.21, P=0.753). Independent predictors of postoperative sepsis included failure of microbiological eradication, higher baseline C-reactive protein, and larger stone burden. Findings were consistent in sensitivity analyses.

CONCLUSION

In this propensity score-matched retrospective cohort, aminoglycoside versus ceftazidime prophylaxis was not independently associated with postoperative sepsis. These findings support consideration of shorter prophylactic strategies in carefully selected patients, but do not establish noninferiority and require confirmation in prospective adequately powered studies.