Clinical and Microbiological Effects of an Antimicrobial Stewardship Program in Urology—A Single Center Before-After Study

Abstract

Antimicrobial resistance is a major public health issue caused by antibiotic overuse and misuse. Antimicrobial stewardship (AMS) has been increasingly endorsed worldwide, but its effect has been studied scarcely in urologic settings. A before-after study was performed from 2018 through 2020 to evaluate changes in antimicrobial prescription, resistance rates and clinical safety upon implementation of an AMS audit and feedback program in the Urology Department of a large German academic medical center. The primary endpoints were safety clinical outcomes: the rate of infection-related readmissions and of infectious complications after transrectal prostate biopsies. Resistance rates and antimicrobial consumption rates were the secondary endpoints. The AMS team reviewed 196 cases (12% of all admitted in the department). The overall antibiotic use dropped by 18.7%. Quinolone prescriptions sank by 78.8% (p = 0.02) and 69.8% (p > 0.05) for ciprofloxacin and levofloxacin, respectively. The resistance rate of E. coli isolates declined against ceftriaxone (−9%), ceftazidime (−12%) and quinolones (−25%) in the AMS period. No significant increase in infection-related readmissions or infectious complications after prostate biopsies was observed (p = 0.42). Due to the potential to reduce antibiotic use and resistance rates with no surge of infection-related complications, AMS programs should be widely implemented in urologic departments.

Clinical-pharmacological drug information center of Hannover Medical School: experiences and analysis from a tertiary care university hospital

“…Reppe and colleagues suggested that “the physical proximity of the [drug information] centers might lower the threshold [for enquirers] to initiate contact” 5 . Based on the results of our study, we can draw similar conclusions: many queries were received from departments with whom close professional cooperations exist, for example through interdisciplinary ward rounds with colleagues from psychiatry 29 or trauma surgery 31 , and through the participation of our institute in the antimicrobial stewardship (AMS) program at Hannover Medical School 32 . Of note, personal contacts may lower the threshold to submit queries to the clinical-pharmacological DIC.…”

Characteristics and Treatment Outcomes of Urologic Patients Admitted to the Intensive Care Unit, Osijek University Hospital Center

“…Early recognition of deterioration in these patients could reduce their mortality ( 20 ). This is possible through targeted administration of antibiotics according to microbiological test results, laboratory analyses, and use of specific monitoring that might indicate the need of intensive treatment earlier ( 26 ). In this way, an appropriate treatment may be initiated earlier, and a relatively large number of urologic patients admitted to the ICU after CPR could be reduced ( 20 ).…”

Do or Don’t: Results of a Multinational Survey on Antibiotic Prophylaxis in Urodynamics

“…Even though striking evidence exists concerning the use of fluoroquinolones, there is a lot of it [28]. On the other hand, implementing AMS programs delivers significant, timely results with lower resistance rates, and reduced prescribed antibiotic doses without forfeiting the patient's safety or morbidity [29].…”