Urinary tract infection and antibiotic use around ureteral stent insertion for urolithiasis.

Urolithiasis is the main indication for a ureteral JJ stent. Our aim was to determine the incidence of urinary tract infections (UTIs) after a JJ stent for urolithiasis, with an emphasis on antibiotic use. Prospective, multicenter, cohort study over a 4-month period including all of the patients with urolithiasis requiring JJ stent insertion. The clinical and microbiological data and therapeutic information were recorded until removal of the JJ stent. Two hundred twenty-three patients at five French private hospitals were included. A urine culture was performed for 187 patients (84%) prior to insertion of a JJ stent, 36 (19%) of which were positive. One hundred thirty patients (58%) received an antibiotic therapy during surgery: 74 (33%) prophylaxis and 56 (25%) empirical antibiotic therapy, comprising 17 different regimens. The rate of prophylaxis varied according to the center, from 0 to 70%. A total of 208 patients were followed-up until removal of the first stent. The rate of UTIs was 6.3% (13/208); 8.1% of the patients who did not receive a prophylaxis had a UTI versus 1.4% of those who did receive a prophylaxis (p = 0.057). Seven empirical antibiotic regimens were used to treat these 13 patients. Another large panel of antibiotic prescriptions was observed at the time of JJ stent removal. The incidence of a UTI after JJ stent insertion for urolithiasis was 6.3%, in part due to a lack of prophylaxis. An unwarranted diversity of antibiotic use was observed at each step of care.