Protocol-based perioperative antimicrobial prophylaxis in urologic surgeries: Feasibility and lessons learned

Area of Science:

• Urology
• Infectious Disease
• Pharmacology

Background:

• Antibiotic resistance is a growing threat, necessitating rational antibiotic use and adherence to guidelines.
• Surgical prophylaxis protocols must be adapted to local bacterial flora for optimal effectiveness.
• A protocol was developed to curb antibiotic overuse in urology and assess its feasibility.

Purpose of the Study:

• To design and evaluate a feasible antibiotic prophylaxis protocol for urological surgeries.
• To reduce the rampant abuse of antibiotics in the urology department.
• To tailor prophylaxis guidelines based on local bacterial patterns.

Main Methods:

• A 5-month study included patients undergoing elective major urological surgeries.
• The protocol, based on European guidelines and local antibiograms, used single-dose cefuroxime for clean/clean-contaminated cases.
• Extended protocols were used for contaminated surgeries; effectiveness was defined by protocol adherence and uneventful recovery.

Main Results:

• The protocol was effective in 89.5% of 277 analyzed patients.
• Higher failure rates (41.7%) were observed in contaminated procedures, significantly linked to postoperative sepsis (P < 0.001).
• Endourological surgeries were disproportionately represented among sepsis cases following protocol failure.

Conclusions:

• Protocol-based perioperative antibiotic prophylaxis is feasible in urological surgery.
• Developing and validating similar protocols at other centers can limit unnecessary antibiotic use.
• These efforts are crucial for preventing the emergence and spread of antibiotic resistance.