Does Antimicrobial Prophylaxis in Patients with Specific Comorbidities Reduce the Risk of Infection after Simple...

Area of Science:

• Urology
• Infectious Disease Prevention
• Clinical Practice Guidelines

Background:

• Post-procedural infections, including urinary tract infections and sepsis, are potential complications of cystourethroscopy.
• The role of antimicrobial prophylaxis in preventing these infections, particularly in patients with comorbidities, requires further investigation.

Purpose of the Study:

• To evaluate the effectiveness of antimicrobial prophylaxis in reducing post-procedural infection rates after simple cystourethroscopy.
• To determine if specific patient comorbidities influence the benefit of antimicrobial prophylaxis.

Main Methods:

• Retrospective review of 8,997 simple cystourethroscopy procedures from August 2014 to December 2019.
• Data analysis using mixed effects logistic regression to assess the impact of antimicrobial prophylaxis and comorbidities on infection risk.

Main Results:

• Antimicrobial prophylaxis was administered in 78% of procedures, with an overall post-procedural infection rate of 0.9%.
• Prophylaxis was associated with lower odds of infection (OR 0.51), but the number needed to treat was 100.
• No significant reduction in infection risk was observed for any comorbidity group.

Conclusions:

• While antimicrobial prophylaxis shows a modest overall benefit in reducing infection after cystourethroscopy, its clinical utility is limited by a high number needed to treat.
• Current patient comorbidities do not appear to be a reliable factor for guiding antimicrobial prophylaxis decisions in this setting.