Abstract
Objective
To quantify the benefits and harms of post-procedural antibiotic use after common
urologic procedures.
Materials and Methods
This retrospective cohort study included patients who underwent an endoscopic urologic
procedure (transurethral resection of bladder tumor, transurethral resection of prostate,
or ureteroscopy) within the Veterans Health Administration between January 1, 2017
and June 30, 2021. A post-procedural antibiotic was any qualifying antibiotic prescribed
for administration on the day after the procedure. Guidelines generally do not recommend
post-procedural antibiotics for surgical prophylaxis. Outcomes included unplanned
return visits and Clostridioides difficile infection within 30 days. Log-binomial models with risk-adjustment were used to measure
the association between post-procedural antibiotic use and outcomes. Hospital-level
observed-to-expected (O:E) ratios were constructed to compare post-procedural antibiotic
use.
Results
There were 74,629 qualifying procedures across 105 hospitals; 27,422 (36.7%) received
post-procedural antibiotics (median 3 days, IQR 3-6). An unplanned return visit occurred
in 20.2% of patients who received post-procedural antibiotics vs 17.2% who did not
(adjusted RR 1.032, 95% CI 0.999-1.066). C. difficile infection was diagnosed in 0.27% vs 0.10% in those who received and did not receive
post-procedural antibiotics (adjusted RR 1.67, 95% CI 1.13-2.45). The O:E ratio for
post-procedural antibiotic use ranged from 0.46 among hospitals in the lowest-use
quartile to 1.93 in the highest-use quartile.
Conclusion
Post-procedural antibiotics were frequently prescribed after urologic procedures with
large inter-facility variability even after adjusting for case-mix differences. Post-procedural
antibiotic use was associated with increased risk for C. difficile infection but not fewer unplanned return visits. Efforts to reduce guideline-discordant
use of post-procedural antibiotics are needed.
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References
- Antibiotic Resistance Threats in the United States, 2019.U.S. Department of Health and Human Services, CDC, Atlanta, GA2019
- Antimicrobial use in European acute care hospitals: results from the second point prevalence survey (PPS) of healthcare-associated infections and antimicrobial use, 2016 to 2017.Euro Surveill. 2018; 23https://doi.org/10.2807/1560-7917.ES.23.46.1800393
- Best practice statement on urologic procedures and antimicrobial prophylaxis.J Urol. 2020; 203: 351-356https://doi.org/10.1097/JU.0000000000000509
- New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective.Lancet Infect Dis. 2016; 16: e276-e287https://doi.org/10.1016/S1473-3099(16)30398-X
- Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017.JAMA Surg. 2017; 152: 784-791https://doi.org/10.1001/jamasurg.2017.0904
- Antibiotic prophylaxis for patients undergoing transurethral resection of the prostate.Urology. 1996; 47: 852-856https://doi.org/10.1016/S0090-4295(96)00066-0
- Prospective comparative study of single dose vs 3-day administration of antimicrobial prophylaxis in minimum incision endoscopic radical prostatectomy.Int J Urol. 2008; 15: 328-331https://doi.org/10.1111/j.1442-2042.2008.02001.x
- A single dose of intraoperative antibiotics is sufficient to prevent urinary tract infection during ureteroscopy.J Endourol. 2016; 30: 63-68https://doi.org/10.1089/end.2015.0511
- American urological association antibiotic best practice statement and ureteroscopy: does antibiotic stewardship help?.J Endourol. 2018; 32: 283-288https://doi.org/10.1089/end.2017.0796
- Variations in perioperative antibiotic prescriptions among academic urologists after ambulatory endoscopic urologic surgery: impact on infection rates and validation of 2019 best practice statement.Urology. 2020; 146: 101-106https://doi.org/10.1016/j.urology.2020.07.049
- Assessment of guideline discordance with antimicrobial prophylaxis best practices for common urologic procedures.JAMA Netw Open. 2018; 1e186248https://doi.org/10.1001/jamanetworkopen.2018.6248
- Association of duration and type of surgical prophylaxis with antimicrobial-associated adverse events.JAMA Surg. 2019; 154: 590-598https://doi.org/10.1001/jamasurg.2019.0569
- Antibiotic prescribing choices and their comparative C. difficile infection risks: a longitudinal case-cohort study.Clin Infect Dis. 2021; 72: 836-844https://doi.org/10.1093/cid/ciaa124
- The benefits and harms of antibiotic prophylaxis for urinary tract infection in older adults.Clin Infect Dis. 2021; 73: e782-e791https://doi.org/10.1093/cid/ciab116
- Use and outcomes of extended antibiotic prophylaxis in urological cancer surgery.J Urol. 2014; 192: 425-429https://doi.org/10.1016/j.juro.2014.02.096
- Antibiotic overuse is a major risk factor for clostridium difficile infection in surgical patients.Infect Control Hosp Epidemiol. 2017; 38: 1254-1257https://doi.org/10.1017/ice.2017.158
- Identifying higher-volume antibiotic outpatient prescribers using publicly available medicare part D data - United States, 2019.MMWR Morb Mortal Wkly Rep. 2022; 71: 202-205https://doi.org/10.15585/mmwr.mm7106a3
Article info
Publication history
Published online: November 02, 2022
Accepted:
October 18,
2022
Received:
July 5,
2022
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Financial support: This work was supported by the Merck Investigator Studies Program, the Iowa City VA Health Care System Department of Pharmacy Services and the Veterans Health Administration Health Services Research and Development Service (BCL, CIN 13-412; DJL CDA 16-204).
Identification
Copyright
Published by Elsevier Inc.
