Do Urologists Adhere to Antibiotic Prophylaxis Guidelines prior to Cystoscopy?

Area of Science:

• Urology
• Infectious Disease Prevention
• Healthcare Quality Improvement

Background:

• Flexible cystoscopy is a common urological procedure with low infectious risk.
• Current guidelines advocate for selective antibiotic prophylaxis (AP) based on patient risk factors, not routine use.
• Real-world adherence to these selective AP guidelines is uncertain.

Purpose of the Study:

• To assess urologist adherence to guideline-recommended AP use before flexible cystoscopy.
• To identify physician-related predictors of non-compliance with AP guidelines.

Main Methods:

• A nationwide anonymous questionnaire surveyed urology specialists in Israel.
• The survey collected data on demographics, academic/clinical characteristics, and AP prescribing patterns.
• Descriptive statistics and multivariate logistic regression analyzed associations between physician characteristics and AP use.

Main Results:

• 20% of responding urologists routinely prescribed AP for all cystoscopy patients, irrespective of risk.
• Academic rank was significantly associated with non-compliance; professors were more likely to prescribe routine AP (p=0.012).
• Academic rank was the sole independent predictor of non-adherence in multivariate analysis (p=0.009).

Conclusions:

• A substantial proportion of urologists deviate from guidelines by routinely prescribing AP before flexible cystoscopy.
• Physician academic rank is a key predictor of non-adherence, possibly due to practice habits.
• Enhanced awareness, stewardship programs, and standardized protocols are needed to promote evidence-based AP use.