Introduction: There is increasing awareness surrounding the unintended deleterious downstream effects of antibiotics such as antibiotic resistance and cancer-specific survival. The American Urological Association recently released guidelines in June of 2019 consistent with more judicious antibiotic use and tailored antibiotic prophylaxis. In anticipation of the changes in antibiotic practice patterns, our objective was to review prior antibiotic practice patterns and infectious rates of three of the most common urologic procedures—cystoscopy, prostate biopsy, and post-prostatectomy catheter removal.
Methods: We retrospectively reviewed the Urology clinic schedule for three months (November 2018-January 2019) for cystoscopy and prostate biopsy and for five months (August 2018-January 2019) for post-prostatectomy catheter removal and identified patients who underwent the procedures of interest. We then recorded antibiotics given for prophylaxis at time of procedure, individual patient risk factors for infection, 30-day infection outcomes, and urine and blood culture data.
Results: We identified 550 cystoscopies, 113 prostate biopsies, and 157 post-prostatectomy catheter removals. Antibiotic prophylaxis practices varied widely. (Figure 1). Infection rates for cystoscopy, prostate biopsy, and post-prostatectomy catheter removal were 3.6%, 5.3%, and 7.0%, respectively. Among those who had an infection following cystoscopy, we fitted a multilinear regression analysis and found that indication for cystoscopy (eg. bladder cancer surveillance) (p<0.05), clean intermittent catheterization (p<0.05), indwelling foley catheter (p<0.05) were statistically significant. For post-prostatectomy catheter removal, we performed a logistic regression analysis, and a patient that did not receive antibiotics was 4.3 times more likely to have a urinary tract infection to patients receiving a single dose (p = 0.03).
Conclusions: We found tremendous variation in antibiotic practices within one academic institution. In the future, we will be evaluating the effect of the new guideline changes on antibiotic procedural prophylaxis patterns and infection rates. Source of