Advertisement

Post-procedural Antibiotic Use and Associated Outcomes After Common Urologic Procedures Across a National Healthcare System

Published:November 02, 2022DOI:https://doi.org/10.1016/j.urology.2022.10.014

      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • CDC
        Antibiotic Resistance Threats in the United States, 2019.
        U.S. Department of Health and Human Services, CDC, Atlanta, GA2019
        • Plachouras D
        • Karki T
        • Hansen S
        • et al.
        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
        • Lightner DJ
        • Wymer K
        • Sanchez J
        • Kavoussi L.
        Best practice statement on urologic procedures and antimicrobial prophylaxis.
        J Urol. 2020; 203: 351-356https://doi.org/10.1097/JU.0000000000000509
        • Allegranzi B
        • Bischoff P
        • de Jonge S
        • et al.
        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
        • Berrios-Torres SI
        • Umscheid CA
        • Bratzler DW
        • et al.
        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
        • Hall JC
        • Christiansen KJ
        • England P
        • et al.
        Antibiotic prophylaxis for patients undergoing transurethral resection of the prostate.
        Urology. 1996; 47: 852-856https://doi.org/10.1016/S0090-4295(96)00066-0
        • Sakura M
        • Kawakami S
        • Yoshida S
        • Masuda H
        • Kobayashi T
        • Kihara K.
        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
        • Chew BH
        • Flannigan R
        • Kurtz M
        • et al.
        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
        • Greene DJ
        • Gill BC
        • Hinck B
        • et al.
        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
        • Davuluri M
        • Bernstein AP
        • Fram E
        • Watts KL.
        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
        • Khaw C
        • Oberle AD
        • Lund BC
        • et al.
        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
        • Branch-Elliman W
        • O'Brien W
        • Strymish J
        • Itani K
        • Wyatt C
        • Gupta K
        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
        • Brown KA
        • Langford B
        • Schwartz KL
        • Diong C
        • Garber G
        • Daneman N.
        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
        • Langford BJ
        • Brown KA
        • Diong C
        • et al.
        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
        • Calvert JK
        • Holt SK
        • Mossanen M
        • et al.
        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
        • Bernatz JT
        • Safdar N
        • Hetzel S
        • Anderson PA.
        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
        • Gouin KA
        • Fleming-Dutra KE
        • Tsay S
        • Bizune D
        • Hicks LA
        • Kabbani S.
        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