Should We Use Antibiotic Prophylaxis for Flexible Cystoscopy? A Systematic Review and Meta-Analysis
Michelle M Carey1, Abdullah Zreik, Neil J Fenn
1Cheltenham General Hospital, Cheltenham, UK.
Introduction:
The role of antibiotic prophylaxis for routine flexible cystoscopy (FC) is not clear due to the varying practices of individual clinicians. There are no formal guidelines, and this may be due to a lack of formal summary of the data.
Methods:
A systematic review was conducted in April 2014 including all randomised control trials on prophylactic antibiotic use for FC. The main outcome measures were confirmed bacteriuria on mid-stream urine (MSU), asymptomatic bacteriuria and symptomatic bacteriuria. A meta-analysis was conducted with difference between groups expressed as an odds ratio (OR) and control group risk.
Results:
5,107 patients were included, 2,173 in placebo and 2,934 in the antibiotic group. The OR for all three outcomes favoured the antibiotic group; the risk of developing symptomatic bacteriuria was 0.06 times more likely in the control group (OR 0.34), 0.054 (OR 0.40) for developing asymptomatic bacteriuria and 0.109 for confirming bacteriuria on MSU (OR 0.36). The number needed to treat (NNT) was 15 (13-19) for MSU positive bacteriuria; 32 (27-42) for symptomatic bacteriuria and 26 (23-33) for asymptomatic bacteriuria.
Conclusions:
Antibiotic prophylaxis did confer a reduction in cases of symptomatic and asymptomatic bacteriuria but the NNT were high. Therefore, the authors cannot advocate the use of antibiotic prophylaxis for routine FC procedures.
Insights
Antibiotic prophylaxis for flexible cystoscopy (FC) reduces bacteriuria, but high NNT suggests it is not routinely recommended. Further research may clarify optimal use cases for this common urological procedure.
Area of Science:
- Urology
- Infectious Diseases
- Evidence-Based Medicine
Background:
- The use of antibiotic prophylaxis for routine flexible cystoscopy (FC) lacks clear guidelines due to varied clinical practices.
- A lack of summarized data contributes to the uncertainty surrounding antibiotic prophylaxis for FC.
Purpose of the Study:
- To systematically review and meta-analyze randomized controlled trials (RCTs) on prophylactic antibiotic use for flexible cystoscopy (FC).
- To evaluate the efficacy of antibiotic prophylaxis in preventing bacteriuria (confirmed, asymptomatic, and symptomatic) following FC procedures.
Main Methods:
- A systematic review of RCTs investigating prophylactic antibiotic use for FC was conducted in April 2014.
- Meta-analysis was performed to determine the odds ratio (OR) for confirmed, asymptomatic, and symptomatic bacteriuria.
- Key outcomes included bacteriuria on mid-stream urine (MSU), asymptomatic bacteriuria, and symptomatic bacteriuria.
Main Results:
- The analysis included 5,107 patients: 2,173 in the placebo group and 2,934 in the antibiotic group.
- Antibiotic prophylaxis significantly reduced the risk of symptomatic bacteriuria (OR 0.34), asymptomatic bacteriuria (OR 0.40), and confirmed bacteriuria on MSU (OR 0.36).
- However, the number needed to treat (NNT) was relatively high, ranging from 15 to 33 for the different bacteriuria outcomes.
Conclusions:
- Antibiotic prophylaxis demonstrated a reduction in symptomatic and asymptomatic bacteriuria following flexible cystoscopy.
- The high NNT values indicate a limited clinical benefit for routine prophylaxis in all patients undergoing FC.
- The authors do not advocate for the routine use of antibiotic prophylaxis in standard flexible cystoscopy procedures based on current evidence.
