Extended Ceftriaxone Prophylaxis and Postoperative Inflammation and Infection-Related Symptoms After Ureteral Lithotripsy with Negative Urine Cultures.

In 30 seconds

This single-center exploratory study, reported as randomized, compared extended preoperative ceftriaxone with a single prophylactic dose in 252 patients with negative urine cultures undergoing rigid ureteroscopic lithotripsy. The extended regimen was associated with lower postoperative inflammatory-marker values on days 1 and 3 and fewer reported infection-related manifestations: 20/122 patients (16.4%) versus 39/130 patients (30.0%) (two-sided Fisher's exact p = 0.012). Confirmed-infection rates by group were not reported, so the findings do not establish that prolonged prophylaxis prevents postoperative infection.

Key findings

• The reported symptom composite occurred in 20/122 patients (16.4%) with extended ceftriaxone and 39/130 patients (30.0%) with a single dose (two-sided Fisher's exact p = 0.012).
• Mean WBC, NEUT%, CRP, and PCT values were lower with extended prophylaxis on postoperative days 1 and 3 (all unadjusted, summary-based p < 0.001).
• Preoperative WBC and stone diameter differed between groups (p = 0.040 and p = 0.025, respectively).

Why it matters

Postoperative inflammatory changes and infection-related symptoms may occur even when preoperative urine cultures are negative. These results suggest a possible association between extended prophylaxis and fewer reported manifestations, but symptoms and inflammatory markers are not equivalent to confirmed infection. Distinguishing these outcomes is important when weighing antibiotic exposure against clinically meaningful benefit.

What to keep in mind

The single-center exploratory study had no prospective sample-size or power calculation; comparisons were unadjusted, and confirmed-infection rates and ceftriaxone-related adverse-event frequencies were not reported. The groups also differed in preoperative WBC and stone diameter.