Is Antibiotic Prophylaxis Required for Flexible Cystoscopy? A Truncated Randomized Double-Blind Controlled Trial

Wilson, L.; Ryan, James; Thelning, C.; Masters, J G; Tuckey, John

doi:10.1089/end.2005.19.1006

Cited by 56 publications

(38 citation statements)

References 3 publications

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“…1). Full manuscripts were evaluated in 12 studies, of which 7 were included into the review [7,11,12,13,17,18,19]. The studies were published between 1971 and 2013, reflecting the time-tested, unanswered question of prophylactic use of antibiotics for FC.…”

Section: Evidence Synthesismentioning

confidence: 99%

“…Seven studies were included [7,11,12,13,17,18,19]. All studies included participants who were for surveillance or diagnostic cystoscopy with a normal urinary tract.…”

Section: Evidence Synthesismentioning

confidence: 99%

“…Six of the studies administered a single dose of antibiotic approximately one hour before FC [7,11,12,13,17,19]. Five studies for each group reported numbers of confirmed bacteriuria on MSU [7,11,12,17,18], asymptomatic bacteriuria [11,13,17,18,19] and symptomatic bacteriuria [11,12,13,17,19]. Three studies performed questionnaire follow-up to assess urinary symptoms [11,12,19] and one study hospitalised patients for the duration of the study to monitor objective parameters, which was the routine practice at that time [18].…”

Section: Evidence Synthesismentioning

confidence: 99%

“…Proteus spp caused 1 positive culture in the placebo group [7]. Johnson, Jiménez Cruz, Wilson and García-Perdomo found Escherichia coli to be the most common organism, with Klebsiella pneumonia , Enterococcus and Streptococcus being other causes [11,13,17,19]. Jimenez-Pacheco found Serrantia liquefaciens grown in one control culture [12].…”

Section: Evidence Synthesismentioning

confidence: 99%

“…There was good quality randomisation, which is described in detail in three studies [11,13,17]. Whereas two other studies did not comment on how they randomised their patients [18,19]. Rané et al allocated in accordance with consultant practice [7] giving rise to a high risk of selection bias.…”

Section: Evidence Synthesismentioning

confidence: 99%

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Should We Use Antibiotic Prophylaxis for Flexible Cystoscopy? A Systematic Review and Meta-Analysis

Carey

Zreik²,

Fenn³

et al. 2015

Urol Int

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Introduction: The role of antibiotic prophylaxis for routine flexible cystoscopy (FC) is not clear due to the varying practices of individual clinicians. There are no formal guidelines, and this may be due to a lack of formal summary of the data. Methods: A systematic review was conducted in April 2014 including all randomised control trials on prophylactic antibiotic use for FC. The main outcome measures were confirmed bacteriuria on mid-stream urine (MSU), asymptomatic bacteriuria and symptomatic bacteriuria. A meta-analysis was conducted with difference between groups expressed as an odds ratio (OR) and control group risk. Results: 5,107 patients were included, 2,173 in placebo and 2,934 in the antibiotic group. The OR for all three outcomes favoured the antibiotic group; the risk of developing symptomatic bacteriuria was 0.06 times more likely in the control group (OR 0.34), 0.054 (OR 0.40) for developing asymptomatic bacteriuria and 0.109 for confirming bacteriuria on MSU (OR 0.36). The number needed to treat (NNT) was 15 (13-19) for MSU positive bacteriuria; 32 (27-42) for symptomatic bacteriuria and 26 (23-33) for asymptomatic bacteriuria. Conclusions: Antibiotic prophylaxis did confer a reduction in cases of symptomatic and asymptomatic bacteriuria but the NNT were high. Therefore, the authors cannot advocate the use of antibiotic prophylaxis for routine FC procedures.

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Section: Evidence Synthesismentioning

confidence: 99%

“…Seven studies were included [7,11,12,13,17,18,19]. All studies included participants who were for surveillance or diagnostic cystoscopy with a normal urinary tract.…”

Section: Evidence Synthesismentioning

confidence: 99%

Section: Evidence Synthesismentioning

confidence: 99%

Section: Evidence Synthesismentioning

confidence: 99%

Section: Evidence Synthesismentioning

confidence: 99%

See 3 more Smart Citations

Should We Use Antibiotic Prophylaxis for Flexible Cystoscopy? A Systematic Review and Meta-Analysis

Carey

Zreik²,

Fenn³

et al. 2015

Urol Int

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Antimicrobial agents for preventing urinary tract infections in adults undergoing cystoscopy

Zeng

Zhang

Bai

et al. 2019

Cochrane Database of Systematic Reviews

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BackgroundCystoscopy is commonly performed for diagnostic purposes to inspect the interior lining of the bladder. One disadvantage of cystoscopy is the risk of symptomatic urinary tract infection (UTI) due to pre-existing colonization or by introduction of bacteria at the time of the procedure. However, the incidence of symptomatic UTI following cystoscopy is low. Currently, there is no consensus on whether antimicrobial agents should be used to prevent symptomatic UTI for cystoscopy. ObjectivesTo assess the e ects of antimicrobial agents compared with placebo or no treatment for prevention of UTI in adults undergoing cystoscopy. Search methodsWe comprehensively searched electronic databases of the Cochrane Library, PubMed, Embase, LILACS, and CINAHL. We searched the WHO ICTRP and ClinicalTrials.gov for ongoing trials. We used no language or date restrictions in the electronic searches. We searched the reference lists of identified articles and contacted authors for related information. The last search of the electronic databases was 4 February 2019. Selection criteriaWe included randomized controlled trials (RCTs) or quasi-RCTs that compared any prophylactic antibiotic versus placebo, no treatment, or other non-antibiotic prophylaxis in adults undergoing cystoscopy. There was no restriction on the dose, frequency, formulation, duration, or mode of administration of the antibiotics. Data collection and analysisWe used standard methodological procedures expected by Cochrane. Our primary outcomes were systemic UTI, symptomatic UTI (composite of systemic and/or localized UTI), and serious adverse events. Secondary outcomes were minor adverse events, localized UTI, asymptomatic bacteriuria, and bacterial resistance. We assessed the quality of evidence using GRADE. Main resultsWe included 20 RCTs and two quasi-RCTs with 7711 participants, all of which compared antibiotic prophylaxis with placebo or no treatment control. We found no studies comparing antibiotic prophylaxis with non-antibiotic prophylaxis. Primary outcomesAntimicrobial agents for preventing urinary tract infections in adults undergoing cystoscopy (Review)

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Preoperative Antibiotics and Prevention of Sepsis in Urologic Endoscopic Surgery

Patel¹,

Gutiérrez-Aceves²

2018

Smith's Textbook of Endourology

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Is Antibiotic Prophylaxis Required for Flexible Cystoscopy? A Truncated Randomized Double-Blind Controlled Trial

Abstract: Infection after flexible cystoscopy is rare and not associated with significant morbidity. A much larger study would be required to determine whether antibiotic prophylaxis significantly reduces the rate of postprocedure UTI.

Cited by 56 publications

References 3 publications

Should We Use Antibiotic Prophylaxis for Flexible Cystoscopy? A Systematic Review and Meta-Analysis

Should We Use Antibiotic Prophylaxis for Flexible Cystoscopy? A Systematic Review and Meta-Analysis

Antimicrobial agents for preventing urinary tract infections in adults undergoing cystoscopy

Preoperative Antibiotics and Prevention of Sepsis in Urologic Endoscopic Surgery

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