Antimicrobial stewardship for asymptomatic bacteriuria prior to urological procedures: A before/after study

In cases of preoperative asymptomatic bacteriuria, to measure improvement in prescribing practices after implementation of an antimicrobial stewardship program prior to urological procedures.

This was a retrospective, single-center before-after study. It consisted of a preintervention phase (December 2022 - June 2023, 196 patients) and a post-intervention phase (January 2024-December 2024, 196 patients). We randomly selected patients from the surgical schedule and examined the antibiotics prescribed for pre-operative asymptomatic bacteriuria. Our multifaceted approach focused on the issues identified during the pre-intervention phase. It encompassed elaboration and distribution of a prescription guide, preferential management by urologists of antibiotic prescriptions, and training sessions every six months. An infectious disease physician (IDP) reviewed each urine culture and determined the most appropriate antibiotic therapy according to antibiotic susceptibility test results. The primary outcome was the overall proportion of discrepancies, consisting in overly broad-spectrum or inactive antibiotics, between the original prescriptions and the IDP review. Secondary endpoints were the specific rate of overly broad-spectrum antibiotic prescriptions and the duration of preoperative antibiotic therapy.

The discrepancy rate decreased after intervention (27.0% vs. 18.4%; P = 0.040), with fewer prescriptions during the post-intervention period of inappropriate broad-spectrum antibiotics (24.0% vs 10.2%; P ≤0.001), particularly fluoroquinolones (18.5% vs 8.1%; P = 0.002), On the other hand, prescription of inactive antibiotic increased (3.1% vs 8.2%; P = 0.028). Median preoperative treatment duration was three days (IQR: 2-4) in the pre-intervention period and two days (IQR: 2-3) in the post-intervention period (P < 0.001).

In treatment of preoperative bacteriuria, antimicrobial stewardship led to significant improvements in antibiotic prescribing. However, inappropriate broad-spectrum prescriptions necessitate continued vigilance. Prescription of inactive antibiotics should be explored so as to better understand its causes and reduce the ensuing infectious complications.