Evaluating the utility of antibiotic prophylaxis prior to ESWL in patients with sterile urine: a systematic review and meta-analysis.

INTRODUCTION To evaluate the effect of antibiotic prophylaxis (AP) on asymptomatic bacteriuria (AB) and urinary tract infection (UTI) in patients with sterile urine undergoing ESWL. EVIDENCE ACQUISITION PubMed, Scopus, Web of Science and Cochrane Registry were searched systematically for randomized clinical trials assessing the effect of AP in patients with sterile urine undergoing SWL up to May 2020. Risk ratios were used to compare dichotomous outcomes. A stratified analysis was performed depending on the risk of bias assessment of the included studies. Subgroup analysis was performed in patients that underwent instrumentation of the urinary tract. EVIDENCE SYNTHESIS 16 studies were evaluated including 2442 patients. When evaluating all the included studies (regardless of the risk of bias assessment), the risk of AB was RR: 0.88, 95% CI:0.64-1.21, p=0.42 and the risk of UTI was RR: 0.55 95% CI: 0.22-1.36, p=0.19. When excluding the high risk of bias studies the risk for AB was RR: 0.9, 95% CI: 0.63-1.28, p=0.55 and for UTI RR: 1.18, 95% CI: 0.38-3.72, p=0.77. When evaluating patients that underwent instrumentation of the urinary tract the risk for AB was RR:0.92, 95% CI: 0.66-1.27, p=0.6 and for UTI was RR: 0.69, 95% CI: 0.22-2.22, p-0.54. CONCLUSIONS AP is not necessary for patients with sterile urine prior to ESWL for the prevention of UTI. Also, patients that undergo instrumentation of the urinary tract prior to or during ESWL do not benefit from antibiotic prophylaxis but further research is required.