Short summary

Percutaneous nephrostomy (PCN) is a well-accepted method used in treating a variety of ailments. The placement of PCN is associated with the risk of developing infections. Though PCN has been used for many decades in Interventional Radiology (IR), the evidence and research on the use of prophylactic antibiotics in relation to PCN exchange is limited. This study aim is to investigate the approach, among urologists, to the use prophylactic antibiotics in relation to a routine PCN catheter exchange

Rationale

Percutaneous nephrostomy (PCN) is a well-accepted method used in treating a variety of ailments, such as urinary obstructions, urinary fistulae, injury in the urinary tract, late sequelae after surgery or radiation treatments in the abdominal or pelvic organs, or to gain access to the collecting system in the kidney to perform different procedures. The purpose of the PCN is to ensure drainage or redirect the urine flow by placing a catheter directly into the calyx of the kidney through the skin, either as a temporary or lifelong solution. Patients with PCN typically undergo catheter exchange every 60-90 days. However, the placement of a PCN is correlated with the risk of developing asymptomatic bacteriuria (ABU), which is the presence of bacteria in a urine culture without the clinical signs of a urinary tract infection (UTI). Furthermore, ABU is associated with an increased risk of developing UTIs and sepsis, especially if the catheter is in place for a period longer than a month. An observational prospective study concluded that over 57% of the cancer patients with indwelling ureteral stents or PCN had ABU. Even though PCN has been used for many decades in Interventional Radiology (IR), the evidence and research on the use of prophylactic antibiotics in relation to PCN catheter exchange is limited and has been influenced by published surgical literature. A search through Pudmed and Clinicaltrials.gov showed a general lack of controlled trial studies investigating the effect of prophylactic antibiotics in relation to a routine PCN catheter exchange, resulting in a general lack of evidence-based guidelines. Therefore, due to the lack of evidence-based guidelines, this study aim to investigate whether the approach among urologists in the Nordic countries is consistent or if there are varying approaches regarding the use of prophylactic antibiotics in relation to a routine percutaneous nephrostomy catheter exchange. Furthermore, we are interested in whether guidelines exits at the included departments.

Description of the cohort

Urologists at different hospitals in Denmark, Sweden and Norway.

Data and biological material

A questionnaire on English. Developed by the authors and consist of 15 questions with 14 multiple- choice response categories and one elaborative question. The questionnaire inquires about the following items: Employment (resident or attending) and country, the participant's experience with treating patients with PCN: how many patients they treat per month with PCN, the department responsible for the procedure, guidelines, and practices regarding the use of prophylactic antibiotics in a routine change of a PCN. Some of the items on the questionnaire are only available as options, if the participant provides certain answers to previous questions.

Collaborating researchers and departments

Department of Urology, Odense University Hospital

• Theresa Junker (RN, PhD, Assistant Professor)
• Karin Andersen (MD, Senior Consultant Urology)

Department of Radiology, Odense University Hospital

• Janni Jensen (BSc, MSc, PhD, Associate Professor)