Kriselle Madamba: My name is Kriselle Madamba and I am a research student with the Department of Urology at the University of California, Irvine, and I'm presenting our work in the following study titled, Antibiotic-Augmented Irrigation During Ureteroscopy Is Associated With Lower Infection Rates In High-Risk Patients. Post-operative infection, including UTI, remains a common concern after ureteroscopy, particularly in high risk patients such as those with diabetes, recurrent infections, or indwelling tubes. To address this, we investigated the use of antibiotic augmented irrigation with Neomycin and Polymyxin B, which offers broad spectrum Gram-negative coverage. We evaluated whether this approach could reduce post-operative infection in high-risk URS patients. We conducted a two-to-one matched cohort study using a prospectively maintained database with over 1000 patients dating from 2020 to 2024. The 30 patients in the treatment group received GU irrigation with Neomycin and Polymyxin B, while the 60 matched control patients received standard saline irrigation.

These high risk URS patients were matched based on demographics and infection risk factors. We compared 30 day infectious outcomes between the two groups. We found that post-operative infectious outcomes favored GU irrigation. SIRS occurred in only 10% of patients in the GU irrigation group versus 18% in controls. Sepsis was completely eliminated in the treatment group compared to 2% in controls. Post-operative UTI within 30 days was seen in 0% of patients in the GU irrigation group compared to 15% in controls. We could not perform conventional logistic regression since no infections occurred in the GU group causing perfect prediction. We found that pre-operative positive urine culture was the only independent predictor of infection. In conclusion, in high-risk URS patients antibiotic augmented irrigation was associated with zero post-operative infections. Further patient recruitment is needed to corroborate these findings.