BACKGROUND Updated in 2019, the American Urological Association's (AUA) Best Practice Statement on Urologic Procedures and Antimicrobial Prophylaxis outlines prophylaxis for percutaneous nephrolithotomy (PCNL). Recent studies have challenged these recommendations. We hypothesized endourologists do not routinely follow the AUA's statement on antibiotic use during PCNL and assessed their prescribing patterns. METHODS A 24-question survey was distributed to members of the Endourological Society. The primary outcome was adherence to the AUA's recommendations. Two multiple logistic regression analyses were performed with demographics and antibiotic preference as predictors of following the AUA. RESULTS A total of 51.4% of endourologists follow the AUA Best Practice Statement for antimicrobial prophylaxis of uncomplicated PCNL. No demographic data was predictive of following the AUA. 90.9% and 83.6% reported they have "never" used the first-line recommendation options of metronidazole and aztreonam, respectively. Preferred antibiotics were cephalosporins (uncomplicated 60%, complicated 52.6%), fluoroquinolones (13.3%, 7.2%), aminoglycosides (12.7%, 17.8%), penicillins (7.9%, 11.2%), carbapenems (0.6%, 0.7%), trimethoprim-sulfamethoxazole (2.4%, 5.9%), fosfomycin (0.6%, 0.7%), nitrofurantoin (2.4%, 2.6%), aztreonam (0%, 0.7%), and clindamycin (0%, 0.7%). For uncomplicated PCNL, 63.1% prescribe ≤ 24 hours of perioperative antibiotics. For complicated PCNL, 16.2% prescribe ≤ 24 hours of perioperative antibiotics while 20.4% begin antibiotics 7 or more days prior. CONCLUSIONS Nearly half of respondents do not follow the AUA's recommendations for antibiotic choice for PCNL. Few endourologists prescribe 7 days of preoperative antibiotics for complicated PCNL despite supporting data. Metronidazole and aztreonam are rarely used as a first line antibiotic choice for PCNL and their roles needs to be further evaluated as first line prophylaxis recommendations. Updates on antibiotic recommendations for PCNL are needed based on current literature, antimicrobial stewardship, and contemporary practice patterns.

中文翻译：

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经皮肾镜取石术的抗菌预防：当代实践模式。

背景 美国泌尿外科协会 (AUA) 关于泌尿外科手术和抗菌药物预防的最佳实践声明于 2019 年更新，概述了经皮肾镜取石术 (PCNL) 的预防措施。最近的研究对这些建议提出了挑战。我们假设腔内泌尿科医生不会定期遵循 AUA 关于 PCNL 期间抗生素使用的声明，并评估了他们的处方模式。方法 向腔内泌尿外科协会成员分发了一份包含 24 个问题的调查问卷。主要结果是遵守 AUA 的建议。以人口统计学和抗生素偏好作为遵循 AUA 的预测因素进行了两次多重逻辑回归分析。结果 共有 51.4% 的腔内泌尿科医生遵循 AUA 最佳实践声明，对无并发症的 PCNL 进行抗菌预防。没有人口统计数据可以预测是否遵循 AUA。90.9% 和 83.6% 的受访者分别表示“从未”使用过一线推荐选项甲硝唑和氨曲南。首选抗生素为头孢菌素类（单纯性 60%，复杂性 52.6%）、氟喹诺酮类（13.3%、7.2%）、氨基糖苷类（12.7%、17.8%）、青霉素类（7.9%、11.2%）、碳青霉烯类（0.6%、0.7%）、甲氧苄啶-磺胺甲恶唑 (2.4%, 5.9%)、磷霉素 (0.6%, 0.7%)、呋喃妥因 (2.4%, 2.6%)、氨曲南 (0%, 0.7%) 和克林霉素 (0%, 0.7%)。对于不复杂的 PCNL，63.1% 的患者在围术期 24 小时内使用抗生素。对于复杂的 PCNL，16.2% 的患者在围手术期 24 小时内服用抗生素，而 20.4% 的患者在 7 天或更长时间前开始使用抗生素。结论 近一半的受访者不遵循 AUA 关于 PCNL 抗生素选择的建议。尽管有数据支持，但很少有腔内泌尿科医生会为复杂的 PCNL 开出 7 天的术前抗生素。甲硝唑和氨曲南很少用作 PCNL 的一线抗生素选择，其作用需要进一步评估作为一线预防建议。需要根据当前文献、抗菌药物管理和当代实践模式更新 PCNL 的抗生素建议。