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Summary
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A behavioral intervention successfully reduced antibiotic use in urologic procedures like cystoscopy and prostate biopsy without increasing infection rates. This approach supports outpatient antibiotic stewardship and guideline adoption.

Keywords:
antibioticsbehavioral interventioncystoscopyimplementationprostate biopsy

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Area of Science:

  • Urology
  • Infectious Diseases
  • Public Health

Background:

  • Antibiotic resistance is a growing concern, necessitating strategies to optimize antibiotic use in outpatient settings.
  • Urologic procedures such as cystoscopy and transrectal prostate biopsy are common indications for antibiotic prophylaxis.

Purpose of the Study:

  • To implement and evaluate a multipronged behavioral intervention aimed at reducing and tailoring antibiotic use for cystoscopy and transrectal prostate biopsy.
  • To assess the impact of the intervention on 30-day infection rates and adherence to antibiotic protocols.

Main Methods:

  • A nonblinded intervention study with preintervention, intervention, and postintervention phases conducted across three urologic outpatient clinics.
  • The intervention included physician and staff education, electronic health record order set modifications, patient questionnaires, and audit feedback.
  • Outcomes measured included 30-day infections, adherence to antibiotic protocols, questionnaire completion, and Escherichia coli antibiograms.

Main Results:

  • The proportion of patients receiving antibiotic prophylaxis for cystoscopy decreased by 33%, and for prostate biopsy by 35%.
  • No significant difference in post-cystoscopy infection rates was observed between preintervention and intervention phases; rates were lower in the postintervention phase.
  • Post-biopsy infection rates remained unchanged across study phases.

Conclusions:

  • A multipronged behavioral intervention effectively reduced and tailored antibiotic use in outpatient urology without increasing 30-day infection risks.
  • This intervention model demonstrates a feasible approach for enhancing outpatient antibiotic stewardship and promoting guideline adherence.