Appropriate antimicrobial prescribing for bacteriuria before urological procedures: A room for improvement

Area of Science:

• Urology
• Infectious Diseases
• Antimicrobial Stewardship

Background:

• Positive preoperative urine cultures necessitate antibiotic therapy to ensure urinary sterilization.
• Antibiotic selection is critical for reducing selective pressure and antimicrobial resistance.
• Current prescription practices by urologists and general practitioners (GPs) warrant evaluation.

Purpose of the Study:

• To assess antibiotic prescription patterns for preoperative positive urine cultures.
• To compare urologist and GP antibiotic choices against infectious disease specialist recommendations.
• To identify areas for improvement in antibiotic stewardship.

Main Methods:

• Retrospective review of 196 preoperative urine cultures (November 2022 - July 2023).
• Data collection on antibiotic class, duration, and prescriber.
• Blind review by infectious disease specialists to determine ideal antibiotic therapy.

Main Results:

• 20% (40/196) of prescriptions differed from specialist recommendations, primarily using broad-spectrum antibiotics.
• 50% of non-conforming prescriptions exceeded the recommended 48-hour duration.
• General practitioners prescribed significantly longer treatment durations (4.84 days vs. 2.99 days, P<0.001).

Conclusions:

• Urologist antibiotic prescribing requires optimization to minimize ecological impact.
• Delegating prescriptions to GPs without specialized training leads to unjustified treatment extensions.
• Improved antibiotic stewardship is needed to reduce resistance and optimize patient outcomes.