Antimicrobial Practice Patterns for Urethroplasty: Opportunity for Improved Stewardship

To evaluate the current antimicrobial administration practice patterns for urethroplasty among genitourinary reconstruction experts. Improper use of antimicrobials is a global concern. The American Urological Association suggests that for perioperative antimicrobial prophylaxis, a single dose of intravenous cephalosporin be administered for open surgery involving the urinary system. No specific guidelines exist for urethral reconstruction.

A 27-question survey was designed to assess antimicrobial practice patterns and was administered to 40 international members of the Society of Genitourinary Reconstructive Surgeons who commonly perform urethroplasty.

The response rate was 85% (n = 34). Preoperative: Seventy-one percent order a urine culture preoperatively despite urine analysis result, and 32% do so 1 week prior. Regardless of catheter status, 41.8% use a urine bacteria threshold of 10K colony-forming units/mL to initiate treatment and ideal duration was 7 days in 35%. Meanwhile, 58.8% would not postpone surgery if preferred duration was not met, and 35% would empirically treat with antimicrobials if a urine culture was not performed. Perioperative: The majority administer 2 antimicrobials intraoperatively with 42% preferring aminoglycoside + penicillin regardless of. Postoperative: Eighteen percent to 24% of respondents continue intravenous antimicrobials for longer than 24 hours. Sixty-one percent administer oral antimicrobials until postoperative catheter removal (2-4 weeks), and the majority give additional antimicrobials at catheter removal.

There is substantial variability and likely overuse of preoperative, perioperative, and postoperative antimicrobial administration for urethroplasty. Extended prophylactic duration is common postoperatively. Antimicrobial stewardship is our responsibility, and opportunity exists for improvement in antibiotic administration in urethral reconstruction. Prospective trials are requisite to establish guidelines for judicious yet effective regimens.