Long-Term Antibiotic Treatment Prior to Laparoscopic Nephrectomy for Xanthogranulomatous Pyelonephritis Improves Postoperative Outcomes: Results from a Multicenter Study.
PURPOSE
Xanthogranulomatous pyelonephritis is a destructive bacterial infection typically necessitating nephrectomy. We hypothesized that long-term preoperative antibiotics would facilitate laparoscopic nephrectomy by reducing the renal inflammation.


MATERIALS AND METHODS
We reviewed the records of all patients with histologically confirmed xanthogranulomatous pyelonephritis at 3 University of California institutions between 2005 and 2018. Patients were stratified by antibiotic treatment duration and surgical approach. Patients treated with long-term preoperative antibiotics (28 days or more of continuous treatment until surgery) were compared to patients treated with short-term antibiotics (less than 28 days) and those who only received single-dose prophylactic antibiotics before surgery. Patient demographics and operative outcomes were analyzed. Complications were assigned by Clavien-Dindo classification.


RESULTS
Among the 61 patients, 51 (84%) were female and mean age was 50 years. There were 21 (34%) open procedures and 40 (66%) laparoscopic procedures. Median duration of antibiotic treatment was 5 days in those who received a short-term treatment and 87 days in those who received long-term treatment. Eleven patients received only prophylactic single-dose antibiotics. Using multivariate analysis among patients undergoing laparoscopic nephrectomy, controlling for preoperative drainage, long-term antibiotics resulted in a 6.5-day shorter length of stay (p=0.023) and less overall as well as milder postoperative complications (p <0.001).


CONCLUSIONS
Greater than or equal to 4 weeks of preoperative antibiotics before laparoscopic nephrectomy for xanthogranulomatous pyelonephritis was associated with shorter length of stay and fewer, less severe postoperative complications.
['Xie|Lillian|L|', 'Tapiero|Shlomi|S|', 'Flores|Alec R|AR|', 'Armas-Phan|Manuel|M|', 'Limfueco|Luke|L|', 'Karani|Rajiv|R|', 'Jiang|Pengbo|P|', 'Cobb|Kaitlan D|KD|', 'Sur|Roger L|RL|', 'Chi|Thomas|T|', 'Landman|Jaime|J|', 'Kaler|Kamaljot S|KS|', 'Clayman|Ralph V|RV|']
D000900:Anti-Bacterial Agents D019072:Antibiotic Prophylaxis D002140:California D003131:Combined Modality Therapy D005260:Female D006801:Humans D010535:Laparoscopy D008297:Male D008875:Middle Aged D009392:Nephrectomy D011183:Postoperative Complications D011705:Pyelonephritis, Xanthogranulomatous D012189:Retrospective Studies
anti-bacterial agents laparoscopy pyelonephritis, xanthogranulomatous