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Nayyar R, Kumar S. Peri-operative antibiotic usage during endourological surgery: A multi-institutional, national-level, cross-sectional audit of prevalent practice pattern in India. Indian J Urol 2023; 39:133-141. [PMID: 37304985 PMCID: PMC10249522 DOI: 10.4103/iju.iju_35_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/12/2023] [Accepted: 03/16/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction Antibiotic use during endourological procedures is often discordant from the reported guidelines, despite the potential risks of antibiotic resistance, adverse effects, and health-care costs. A nationwide audit was conducted, with the support of the Urological Society of India, to ascertain the current antibiotic prescription practices for the endourological procedures and the reasons associated with them. Methods A multi-institutional, national-level, cross-sectional audit analyzing elective endourological procedures was performed. The data regarding the disease profile; risk factors for infectious complications; urine culture; pre-, per-, and post-operative antibiotic use; additional antibiotic use; and patient demographics were collected in a standardized pro forma. Reasons for prescribing antibiotics divergent from the guideline recommendations were also noted. Any infectious complication that necessitated the antibiotic use was also noted prospectively up to 1 month. All the data were entered into a single centralized and customized online portal on a real-time basis. Results One thousand five hundred and thirty-eight cases were recruited from 20 hospitals. A single-dose prophylaxis was prescribed in only 319 (20.7%) of the cases, and the majority received a multi-day prophylaxis. A combination of two or more antibiotics was prescribed as the prophylaxis in 51% of the cases. One thousand three hundred and fifty-six (88.2%) cases were continued on a long-duration prophylaxis after the discharge, with 1191 (77.4%) receiving it for > 3 days. One thousand one hundred and sixty (75.4%) cases received a guideline-discordant prophylaxis solely on the basis of the surgeon's or institution's protocol, rather than any specific case based need. Ninety eight (6.4%) cases developed postoperative urinary tract infection. Conclusions Multi-dose, combination and post-discharge antibiotic prophylaxis for endourological surgeries is highly prevalent in India. This audit highlights the huge potential to reduce such guideline-discordant overuse of antibiotics during the endourological procedures.
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Affiliation(s)
- Rishi Nayyar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Shritosh Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Collaborative Working Group on Use of Antibiotics in Endourology
- CWG-UAE (Ajay Anand - Department of Urology, Government Medical College, Jammu, Jammu and Kashmir, India; Arabind Panda - Department of Urology and Renal Transplantation, AIG Hospitals, Hyderabad, Telangana, India; Arun Chawla - Department of Urology, Kasturba Medical College, Manipal, Karnataka, India; Devendra Kumar Sharma - Department of Urology and Renal Transplant, CK Birla Hospital (RBH), Jaipur, Rajasthan, India; Harprit Singh - Department of Urology, Mercy Hospital, Baridih, Jamshedpur, Jharkhand, India; Ishwar Ram Dhayal - Department of Urology and Renal Transplant, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India; Mahendra Singh - Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India; Neeraj Agarwal - Department of Urology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India; Pamposh Raina - Department of Urology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India; P. V. L. N. Murthy - Department of Urology, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India; Ramesh D - Department of Urology, Ramaiah Medical College, Ramaiah University of Applied Sciences, Bangalore, Karnataka, India; Sameer Trivedi - Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India; T Srikala Prasad - Department of Urology, Government Medical College, Chengalpattu, Tamil Nadu, India; Stephen Lalfakzuala Sailo - Department of Urology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India; Sudheer K Devana - Department of Urology, Post-Graduate Institute of Medical Education and Research, Chandigarh, India; Sujata Patwardhan - Department of Urology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India; Vijay Madduri - Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, Telangana, India; Vikas Kumar Panwar - Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Benseler A, McDermott CD. Use of Prophylactic Antibiotics to Prevent Urinary Tract Infection After Urodynamic Testing and Cystoscopy in Women: A Practice Pattern Study. Gynecol Obstet Invest 2022; 87:116-123. [PMID: 35354149 DOI: 10.1159/000524266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/14/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine practice patterns of prescribing prophylactic antibiotics against urinary tract infection (UTI) for urodynamic studies (UDS) and outpatient cystoscopy in women. DESIGN A cross-sectional survey study was conducted of North American female pelvic medicine and reconstructive specialists (FPMRS). METHODS An online survey was used to assess prophylactic prescribing patterns of FPMRS specialists that perform UDS and outpatient cystoscopy. This survey was developed and then electronically disseminated through the American Urogynecologic Society to 699 eligible physicians. RESULTS A total of 138 surveys were completed. Approximately half of physicians did not prescribe any antibiotic prophylaxis for UDS or for cystoscopy (54% and 43%, respectively). For patients with perceived risk factors (recurrent urinary tract infections, immunosuppression, known neurogenic lower urinary tract dysfunction, indwelling catheter use, elevated post void residual/bladder outlet obstruction, genitourinary anomalies, and diabetes), 32% and 41% of physicians prescribed antibiotic prophylaxis for UDS and cystoscopy, respectively. A minority of physicians always prescribed antibiotics for UDS and cystoscopy (13% and 17%, respectively). LIMITATIONS The response rate was a limitation of the study, however, this rate is in keeping with other physician survey studies published within this subspecialty. Selection and response biases may have contributed to the results of this survey study. CONCLUSION There was no uniform approach to urinary tract infection prophylaxis for UDS and outpatient cystoscopy in women which reflects the lack of current guidelines and the low level of evidence on which they are based. This non-uniform practice calls for more research to better define an evidence-based standard of care.
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Affiliation(s)
- Anouk Benseler
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Colleen D McDermott
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Chahal HS, Sikka S, Kaur S, Mittal V, Aulakh BS, Sharma S. A Randomized Controlled Trial to Study the Rationale of Antibiotic Prophylaxis in Diagnostic Rigid Cystoscopy: A Relook in The Era of Antibiotic Stewardship. Int J Appl Basic Med Res 2021; 11:171-176. [PMID: 34458120 PMCID: PMC8360220 DOI: 10.4103/ijabmr.ijabmr_565_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/02/2020] [Accepted: 02/19/2021] [Indexed: 11/04/2022] Open
Abstract
Background In the era of widespread antibiotic (AB) resistance, the role of prophylaxis in diagnostic cystoscopy is controversial. Aim This study aimed to compare the incidence of postcystoscopy positive urinary culture (PC-PUC) and urinary tract infection (UTI) in patients undergoing diagnostic rigid cystoscopy with and without prophylaxis with preprocedural single-dose intravenous AB. Materials and Methods This prospective study was done in patients with preprocedural sterile urine undergoing elective diagnostic rigid cystoscopy. Patients were randomized into two groups, with one group receiving preprocedure single dose of intravenous cefuroxime sodium as prophylaxis half to 1 h before the procedure (Group AB prophylaxis) and the other group receiving no antibiotic prophylaxis (Group NAB). All patients were followed up till 1-month postprocedure, for any symptoms of urinary infection, mandatory urine microscopy and culture at 24-48 h, 1 week and 4 weeks post procedure, and addition sample in case of any urinary symptoms or fever. Results A total of 225 patients were studied, with 110 in AB prophylaxis and 115 in NAB groups. The use of prophylaxis did not decrease the incidence of PC-PUC (8.7%-3.6%; P = 0.167) or UTI (6.1%-1.8%; P = 0.102). Females and diabetics had significantly higher risk of PC-PUC, on univariate and multivariate analysis, not affected by prophylaxis. Conclusion Preprocedural AB prophylaxis does not decrease the incidence of postcystoscopy bacteriuria significantly. Females and diabetics have significantly increased risk, but prophylaxis has no role in them either.
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Affiliation(s)
| | - Shagun Sikka
- Department of Urology, Punjab Institute of Medical Sciences, Jalandhar, Punjab, India
| | - Simran Kaur
- Department of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Varun Mittal
- Satguru Pratap Hospital, Ludhiana, Punjab, India
| | | | - Sandeep Sharma
- Department of Urology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Olivero A, Riccardi N, Ndrevataj D, Balzarini F, Cerasuolo M, Bottino P, Borghesi M, Dodi F, Terrone C. Flexible cystoscopy for ureteral stent removal without antimicrobial prophylaxis. A prospective observational study. Urologia 2020; 88:130-134. [PMID: 33325327 DOI: 10.1177/0391560320980897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Flexible cystoscopy for ureteral stent removal after ureteroscopy is widely performed. In this scenario, the real need for antimicrobial prophylaxis is still uncertain. Aim of this study is to determine the urinary tract infections rate after 4 weeks from outpatient flexible cystoscopies for ureteral stent removal without antimicrobial prophylaxis. PATIENTS AND METHODS A prospective observational study was performed between November 2017 and August 2018 in a single, high-volume Institution.Risk factors for UTIs were recorded. Immediately before cystoscopy, each patient submitted a voided urine specimen. Antibiotics were not given before or after cystoscopy. About 7 and 28 days after cystoscopy all the patients underwent abdomen US, urine analysis and culture, and clinical evaluation to assess possible symptoms of UTI. RESULTS A total of 192 patients were enrolled in the study, 76 patients (39.2%) were female. Median age was 55 years [IQR 47- 68]. Median BMI was 24.2 [22.9-26.7]. Eighteen patients (9.4%) had asymptomatic bacteriuria before cystoscopy and 39 (20.3%) had positive culture at 7 days. About 21 patients (10.9%) were diagnosed with febrile UTI in the 28 days FU period. The 28.6 % of the Febrile patients had asymptomatic bacteriuria before the stent removal (p < 0.001), this group was slightly older (p = 0.085) and with higher BMI (p = 0.036).Forty-eight patients had positive urine culture at 7 days, of whom 27 (14.1%) were asymptomatic and were classified as asymptomatic bacteriuria. Multivariate analysis shows that only high BMI and bacteriuria before the procedure were significantly associated with developing a febrile UTI, none of the other risk factors was significant. CONCLUSION Our data show a high rate of UTI after flexible cystoscopies for ureteral stent removal without antimicrobial prophylaxis especially in patients with asymptomatic bacteriuria, in those with high BMI and in the elderly; in these subgroups, antimicrobial prophylaxis should be recommended.
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Affiliation(s)
- Alberto Olivero
- Department of Urology, San Martino Policlinico Hospital, IRCCS for Oncology, Genoa, Italy
| | - Niccolò Riccardi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Drilona Ndrevataj
- Department of Urology, San Martino Policlinico Hospital, IRCCS for Oncology, Genoa, Italy
| | - Federica Balzarini
- Department of Urology, San Martino Policlinico Hospital, IRCCS for Oncology, Genoa, Italy
| | - Mattia Cerasuolo
- Department of Urology, San Martino Policlinico Hospital, IRCCS for Oncology, Genoa, Italy
| | - Paolo Bottino
- Department of Urology, San Martino Policlinico Hospital, IRCCS for Oncology, Genoa, Italy
| | - Marco Borghesi
- Department of Urology, San Martino Policlinico Hospital, IRCCS for Oncology, Genoa, Italy.,Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, Italy
| | - Ferdinando Dodi
- Clinic of Infectious Diseases, San Martino Policlinico Hospital, IRCCS for Oncology, Genoa, Italy
| | - Carlo Terrone
- Department of Urology, San Martino Policlinico Hospital, IRCCS for Oncology, Genoa, Italy.,Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, Italy
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Zeng S, Zhang Z, Bai Y, Sun Y, Xu C. Antimicrobial agents for preventing urinary tract infections in adults undergoing cystoscopy. Cochrane Database Syst Rev 2019; 2:CD012305. [PMID: 30789676 PMCID: PMC6383548 DOI: 10.1002/14651858.cd012305.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Cystoscopy is commonly performed for diagnostic purposes to inspect the interior lining of the bladder. One disadvantage of cystoscopy is the risk of symptomatic urinary tract infection (UTI) due to pre-existing colonization or by introduction of bacteria at the time of the procedure. However, the incidence of symptomatic UTI following cystoscopy is low. Currently, there is no consensus on whether antimicrobial agents should be used to prevent symptomatic UTI for cystoscopy. OBJECTIVES To assess the effects of antimicrobial agents compared with placebo or no treatment for prevention of UTI in adults undergoing cystoscopy. SEARCH METHODS We comprehensively searched electronic databases of the Cochrane Library, PubMed, Embase, LILACS, and CINAHL. We searched the WHO ICTRP and ClinicalTrials.gov for ongoing trials. We used no language or date restrictions in the electronic searches. We searched the reference lists of identified articles and contacted authors for related information. The last search of the electronic databases was 4 February 2019. SELECTION CRITERIA We included randomized controlled trials (RCTs) or quasi-RCTs that compared any prophylactic antibiotic versus placebo, no treatment, or other non-antibiotic prophylaxis in adults undergoing cystoscopy. There was no restriction on the dose, frequency, formulation, duration, or mode of administration of the antibiotics. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our primary outcomes were systemic UTI, symptomatic UTI (composite of systemic and/or localized UTI), and serious adverse events. Secondary outcomes were minor adverse events, localized UTI, asymptomatic bacteriuria, and bacterial resistance. We assessed the quality of evidence using GRADE. MAIN RESULTS We included 20 RCTs and two quasi-RCTs with 7711 participants, all of which compared antibiotic prophylaxis with placebo or no treatment control. We found no studies comparing antibiotic prophylaxis with non-antibiotic prophylaxis.Primary outcomesSystemic UTI: antibiotic prophylaxis may have little or no effect on the risk of systemic UTI compared with placebo or no treatment (risk ratio (RR) 1.12, 95% confidence interval (CI) 0.38 to 3.32; 5 RCTs; 504 participants; low-quality evidence); this corresponds to two more people (95% CI 12 fewer to 46 more) per 1000 people developing a systemic UTI. We downgraded the quality of the evidence for study limitations and imprecision.Symptomatic UTI: antibiotic prophylaxis may reduce the risk of symptomatic UTI (RR 0.49, 95% CI 0.28 to 0.86; 11 RCTs; 5441 participants; low-quality evidence); this corresponds to 30 fewer people (95% CI 42 fewer to 8 fewer) per 1000 people developing a symptomatic UTI when provided with antibiotic prophylaxis. We downgraded the quality of the evidence for study limitations and potential publication bias.Serious adverse events: the studies reported no serious adverse events in either the intervention group or control group and no effect size could be calculated. Antibiotic prophylaxis may have little or no effect on serious adverse events (4 RCTs, 630 participants; very low-quality evidence), but we are very uncertain of this finding. We downgraded the quality of the evidence for study limitations and very serious imprecision.Secondary outcomesMinor adverse events: prophylactic antibiotics may have little or no effect on minor adverse events when compared with placebo or no treatment (RR 2.82, 95% CI 0.54 to 14.80; 4 RCTs; 630 participants; low-quality evidence). We downgraded the quality of the evidence for study limitations and imprecision.Localized UTI: prophylactic antibiotics may have little or no effect on the risk of localized UTI (RR 1.0, 95% CI 0.06 to 15.77; 1 RCT; 200 participants; very low-quality evidence), but we were very uncertain of this finding. We downgraded the quality of the evidence for study limitations and very serious imprecision.Bacterial resistance: prophylactic antibiotics may increase bacterial resistance (RR 1.73, 95% CI 1.04 to 2.87; 38 participants; 2 RCTs; very low-quality evidence), but we were uncertain of this finding. We downgraded the quality of the evidence for study limitations, indirectness, and imprecision.We were able to perform few secondary analyses; these did not suggest any subgroup effects. AUTHORS' CONCLUSIONS Antibiotic prophylaxis may reduce the risk of symptomatic UTI but not systemic UTIs. Serious and minor adverse events may not be increased with the use of antibiotic prophylaxis. The findings are informed by low- and very low-quality evidence ratings for all outcomes.
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Affiliation(s)
- Shuxiong Zeng
- Changhai Hospital, Second Military Medical UniversityDepartment of UrologyChanghai Road 168#Yangpu DistrictShanghaiChina200433
| | - Zhensheng Zhang
- Changhai Hospital, Second Military Medical UniversityDepartment of UrologyChanghai Road 168#Yangpu DistrictShanghaiChina200433
| | - Yu Bai
- Changhai Hospital, Second Military Medical UniversityDepartment of Gastroenterology/Center for Clinical Epidemiology & Evidence‐Based Medicine18th Floor168 Changhai RdShanghaiChina200433
| | - Yinghao Sun
- Changhai Hospital, Second Military Medical UniversityDepartment of UrologyChanghai Road 168#Yangpu DistrictShanghaiChina200433
| | - Chuanliang Xu
- Changhai Hospital, Second Military Medical UniversityDepartment of UrologyChanghai Road 168#Yangpu DistrictShanghaiChina200433
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