Antibiotic prophylaxis in urologic interventions: Who, when, where?

Area of Science:

• Urology
• Infectious Disease Prevention
• Pharmacology

Background:

• Periprocedural prophylaxis aims to reduce infection risk using physical, chemical, or pharmacological means.
• Antibiotic prophylaxis (AP) involves short-term antibiotic use before procedures to prevent infectious complications.
• Multidrug-resistant bacteria and ecosystem changes complicate standardized AP in urology.

Purpose of the Study:

• Review literature and guidelines on AP for urological procedures.
• Define optimal agents, timing, and indications for pharmacological prophylaxis.
• Explore scenarios where AP may be beneficial or unnecessary.

Main Methods:

• Literature review
• Guideline analysis
• Evidence synthesis on AP efficacy in urology

Main Results:

• AP is beneficial for many invasive procedures and at-risk patients.
• AP is not routinely recommended for urodynamic exams, diagnostic cystoscopy, or lithotripsy.
• AP is mandatory for transrectal prostate biopsy, with unclear evidence for transperineal biopsy; it's standard for ureteroscopy, PCNL, TURBT, TURP, and major surgeries.

Conclusions:

• Significant evidence gaps exist in urological AP.
• Patient-specific factors (comorbidities, immunocompetence) and intervention type are critical for AP decisions.
• A tailored, individualized approach to AP is necessary, moving beyond a one-size-fits-all strategy.