Antimicrobial Practice Patterns for Urethroplasty: Opportunity for Improved Stewardship

Area of Science:

• Urology
• Infectious Disease
• Surgical Practice

Background:

• Antimicrobial misuse is a global health concern.
• Current American Urological Association guidelines recommend single-dose prophylaxis for open urinary surgery, but lack specific recommendations for urethroplasty.
• Urethroplasty, a complex reconstructive procedure, requires careful consideration of antimicrobial use.

Purpose of the Study:

• To evaluate current antimicrobial administration practices among experts in genitourinary reconstruction performing urethroplasty.
• To identify areas of variability and potential overuse in antimicrobial prophylaxis for urethroplasty.

Main Methods:

• A 27-question survey was distributed to 40 international members of the Society of Genitourinary Reconstructive Surgeons.
• The survey assessed preoperative, perioperative, and postoperative antimicrobial prescribing habits for urethroplasty.
• A response rate of 85% (34 surgeons) was achieved.

Main Results:

• Significant variability exists in preoperative practices, including routine urine cultures and treatment thresholds.
• Perioperative administration often involves multiple antibiotics, with common use of aminoglycoside plus penicillin.
• Postoperative antimicrobial use is frequently extended, with 61% administering oral antibiotics for 2-4 weeks until catheter removal.

Conclusions:

• Substantial variability and likely overuse of antimicrobials are evident in urethroplasty practice.
• Extended postoperative prophylactic duration is a common finding.
• There is a clear need for antimicrobial stewardship and prospective trials to establish evidence-based guidelines for antibiotic use in urethral reconstruction.