Preoperative Antibiotics Prior to Bladder Biopsy: are They Necessary?

Objectives To compare postoperative infectious outcomes of bladder biopsies performed in the office without antibiotic prophylaxis versus those done with preoperative antibiotic prophylaxis in the operating room. Methods Our IRB-approved database was retrospectively reviewed for patients who underwent bladder biopsy in the office or in the operating room (OR) between 7/2014 and 8/2015. All patients with bladder biopsies performed in the OR and none in the office received preoperative antibiotic prophylaxis. Patient characteristics and post-procedural outcomes including bacteriuria, urinary tract infection (UTI), and febrile UTI were recorded. The rates of these outcomes were compared between the two groups using the chi-squared test. Patients were excluded from analysis if they experienced a UTI or were prescribed antibiotics within 30 days prior to their procedure. Results In all, 216 biopsies were identified (106 in the office and 110 in the OR). No difference was noted in the rate of UTI (0.94% vs 0.91%, p=0.98), or febrile UTI (0% vs 0.91%, p=0.33) between those undergoing bladder biopsy in the office versus the operating room. There was no difference in the incidence of new urinary symptoms (2.8% vs 5.5%, p=0.33) or post-procedural bacteriuria (3.8% vs 3.6%, p=0.96). Conclusions Since the introduction of the mandated use of antibiotics for routine procedures such as bladder biopsy, antibiotic use has markedly increased. Our data suggest that the preoperative antibiotic prophylaxis that is recommended may not confer benefit to select patients. At a time when antibiotic stewardship is of utmost importance, guidelines regarding its use should be reconsidered.

Urology. 2017 Aug 29 [Epub ahead of print]

Michael J Lipsky, Christopher Sayegh, Marissa C Theofanides, Mitchell C Benson, Kimberly L Cooper

Department of Urology, New York Presbyterian Hospital/ Columbia University Medical Center, New York, NY 10032. Electronic address: ., Department of Urology, New York Presbyterian Hospital/ Columbia University Medical Center, New York, NY 10032.

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