Does a continuous low-dose antibiotic treatment lower the rates of urinary tract infections and stent related symptoms in patients with ureteral stents compared to a periinterventionel prophylaxis only?

The implantation of double J stents is a widely used intervention in the management of patients suffering from obstructing urinary stones. Nevertheless, two main complications are frequent, namely urinary tract infection (UTI) and stent related symptoms (SRS). The reported rates for UTI range from 2% to 34%. Risk factors known to particularly increase the incidence of clinically relevant UTIs are various i.e. underlying systemic disease (e.g. diabetes mellitus, chronic renal failure), female gender or stent indwelling time. SRS such as dysuria, flank pain, hematuria and/or increased voiding frequency are common and can seriously impact daily activities, impair sexual function and even decrease work capacity. Therefore UTI and SRS can significantly reduce patient’s quality of life and consecutively lead to an increase of healthcare costs. For the prevention of UTI a periinterventional antibiotic prophylaxis during double J stent implantation is recommended by the European Association of Urology. However, there is a lack of evidence for the exact antibiotic strategy regarding the entire double J stent indwelling time. In the clinical routine it is a common and widely used practice among urologists to continue a low dose antibiotic treatment for the entire stent indwelling time with the conception to reduce the prevalence of UTI and to possibly obtain a positive effect on SRS rates. To the best of our knowledge there exists neither evidence for the benefit nor for possible disadvantages of such an established empiric prevention. We therefore compared UTI and SRS rates in patients given a continuous low-dose antibiotic treatment for the entire stent indwelling time versus periinterventional antibiotic prophylaxis only. Additionally, the impact of drug side effects, potentially limiting the use of long-term antibiotics, was analyzed.