Antimicrobial stewardship in urology

Abstract

The emergence and spread of antibiotic-resistant bacteria have been reported for various infections. Infections caused by such bacteria are associated with higher rates of patient morbidity and mortality, and increased healthcare costs. In our urological community, we have observed fluoroquinolone resistance in clinical strains of Escherichia coli isolated even from young women with acute uncomplicated cystitis. 1 We have increasingly encountered some bacterial species that produce an extended spectrum β-lactamase in patients with complicated urinary tract infections.2 In male urethritis, oral regimens of fluoroquinolones or third-generation cephalosporins are no longer recommended for treatment of gonorrhea because of antibioticresistant Neisseria gonorrhoeae. 3In the urological community, clinical practice guidelines exist for antibiotic treatment and prophylaxis. The 2006 guidelines for perioperative antimicrobial prophylaxis in urological surgery were approved by the Japanese Urological Association (JUA).4 A survey on antimicrobial prophylaxis reported that of the principal JUA-certified urological training institutions, 6.5% "completely" and 69.7% "mainly" followed the guidelines. However, the guidelines were followed in 48.5% of open clean operations, 43.2% of prostate biopsies and 42.2% of cystoscopies.

How Does Antimicrobial Stewardship Affect Inappropriate Antibiotic Therapy in Urological Patients?

“…Most ICDs are internal medical doctors (physicians) who are familiar with medications, but not with surgical interventions such as drainages [4]. Therefore, surgeons need to be included in the ASTs as well as in infection control teams (ICTs), to achieve the best outcomes for surgical patients [5]. Especially in the case of urinary tract infection (UTI), physicians often make late decisions to carry out drainage or use of invalid antibiotics that possibly generate resistance in bacteria.…”