Outpatient urological procedures in antibiotic-naive patients with bladder cancer with asymptomatic bacteriuria

Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Urine culture and antibiotics are usually given before outpatient urological procedures, namely cystoscopy or intravesical BCG therapy. Injudicious use of antibiotics promotes multidrug bacterial resistance. Pretreatment antibacterial therapy may not be necessary before outpatient urological procedures in patients with bladder cancer. Such strategy facilitates timely intervention and avoids antibiotic resistance.

•  To investigate the frequency of infectious complications after intravesical BCG therapy or cystoscopy in antibiotic-naive patients with bladder tumours who have asymptomatic bacteriuria. •  The aim was to avoid antibiotics in infected patients undergoing these common outpatient urological procedures.

•  A total of 354 patients received induction BCG therapy and another 663 patients underwent cystoscopy after submitting a voided urine sample for culture. They received no antibiotics before or after the procedure. •  Significant bacteriuria was defined as >10(4) or >10(5) colony-forming units per millilitre with a single organism. •  The patients were followed for 3 months for onset of febrile UTI, defined as dysuria and fever >38 °C requiring antibiotics.

•  Ninety BCG-treated patients (25%) and 114 cystoscopy patients (17%) had bacteriuria. •  After BCG therapy, two patients with infected urine (2.2%) and three with sterile cultures (1.1%) had febrile UTIs (P= 0.17). •  After cystoscopy, four infected patients (3.5%) and five uninfected patients (1%) had febrile UTIs (P= 0.08). •  All UTIs resolved within 24 h with oral antibiotics, and none of the patients was admitted for bacterial sepsis.

•  Antibacterial prophylaxis before intravesical BCG therapy or outpatient cystoscopy does not appear to be necessary in patients with asymptomatic bacteriuria. •  Such strategy avoids overuse of antibiotics, reducing drug-resistant bacterial infections.