American Urological Association Antibiotic Best Practice Statement and Ureteroscopy - Does Antibiotic Stewardship Help? Beyond the Abstract

Ureteroscopy is a common urologic surgery.  Despite the American Urological Association releasing a best practice statement recommending less than 24 hours of perioperative antibiotic prophylaxis, there exists significant variability in practice patterns. 

This study examined the effects on outcomes of prescribing a course of postoperative, home-going antibiotics after uncomplicated ureteroscopy. Specifically, rates of postoperative urinary tract infection and unplanned healthcare encounters were assessed.  A retrospective review was performed of all patients undergoing ureteroscopy with a negative preoperative urine culture.  Postoperative urinary tract infection was defined as a positive urine culture within the 30 days following surgery. 

Of the more than 1,000 ureteroscopies analyzed, about one third did not receive home going antibiotics, in accordance with the American Urological Association best practice statement.   Overall, the urinary tract infection rates were low, with (2.9%) or without (3.6) home-going antibiotics, and did not significantly differ between the groups.  The only factor associated with post-operative urinary tract infection was a positive urine within the year prior to surgery.  Rates of unplanned healthcare encounters did not differ either with or without antibiotics.  
Although this is a retrospective study, it provides evidence to support limiting antibiotics to the perioperative setting only.  The rate of postoperative urinary tract infections was higher in patients with a positive urine culture during the year prior to ureteroscopy, suggesting patient-specific modifiable factors may exist that can be targeted preoperatively.   

Written by: Daniel Greene MD, Bradley Gill MD, Manoj Monga MD.

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