Overuse of antimicrobial prophylaxis in low-risk patients undergoing transurethral resection of the prostate

Bausch, Kathrin; Roth, Jan A; Seifert, H.; Widmer, Andreas F.

doi:10.4414/smw.2018.14594

Cited by 8 publications

(6 citation statements)

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“…Unfortunately, the adherence to the EAU guidelines is not optimal. Antimicrobials are often used without a sound rationale, and evidence suggests that >50% of clinicians do not follow the guidelines for the use of antimicrobial agents [30] , [31] , [32] . The literature search outlined that there are several differences between EAU guidelines and American Urological Association/Canadian Urological Association/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction guidelines, leading to contradictory and inconsistent recommendations [33] .…”

Section: Evidence Synthesismentioning

confidence: 99%

Adherence to European Association of Urology Guidelines and State of the Art of Glycosaminoglycan Therapy for the Management of Urinary Tract Infections: A Narrative Review and Expert Meeting Report

Bonkat

Cai²,

Galeone³

et al. 2022

European Urology Open Science

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Section: Evidence Synthesismentioning

confidence: 99%

Adherence to European Association of Urology Guidelines and State of the Art of Glycosaminoglycan Therapy for the Management of Urinary Tract Infections: A Narrative Review and Expert Meeting Report

Bonkat

Cai²,

Galeone³

et al. 2022

European Urology Open Science

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“…Preprocedural urine cultures were collected in 325 of 375 patients (86.7%) (Table 1). The most recent urine culture was performed a median (interquartile [IQR]) of 11 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) days before the procedure, and 106 of 325 patients (32.6%) had bacteriuria or candiduria. Management of preprocedural urine culture screening and treatment was considered inappropriate in 104 patients (27.7%).…”

Section: Manual Medical Record Review At Vha Sitesmentioning

confidence: 99%

“…6(p13) Surveys have demonstrated variability among urologists in their perceived adherence to the professional guidelines. 7,8 Few studies, however, have assessed whether antimicrobial prescribing behavior among urologists actually follows guideline recommendations. [9][10][11] Mossanen et al 10 used a large health care database to assess antimicrobial appropriateness in patients who had urologic procedures from 2007 to 2012.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Guideline Discordance With Antimicrobial Prophylaxis Best Practices for Common Urologic Procedures

et al. 2018

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Key Points Question Do urologic clinicians within the Veterans Health Administration system adhere to the American Urological Association’s antimicrobial prophylaxis guideline for endoscopic urologic procedures? Findings In this cohort study analyzing the medical records of 375 patients at 5 Veterans Health Administration hospitals and the administrative data of 29 530 records throughout the entire Veterans Health Administration system, antimicrobial prescribing was guideline discordant in nearly 60% of patients, the rate of excessive postprocedural antimicrobial use was high, and nearly 40% of records received a median of 3 excess days of antimicrobial therapy. Agreement between these 2 data sources was high. Meaning In patients who underwent common urologic procedures, the rates of guideline-discordant antimicrobial use were high, mainly because of overprescribing of postprocedural antimicrobial agents.

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“…In a preliminary study, we observed a non-adherence in TURP and GL to the recommended single-dose AP of more than 70% amongst urologists in Switzerland, Germany and Austria. AP in TURP and GL was regularly extended up to several days; the most common duration of AP was 2–3 days [8].…”

Section: Introductionmentioning

confidence: 99%

Single-dose versus 3-day cotrimoxazole prophylaxis in transurethral resection or greenlight laser vaporisation of the prostate: study protocol for a multicentre randomised placebo controlled non-inferiority trial (CITrUS trial)

Speich

Bausch

Roth

et al. 2019

Trials

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Background Transurethral resection of the prostate (TURP) and Greenlight laser vaporisation (GL) of the prostate are frequently performed urological procedures. For TURP, a single-dose antimicrobial prophylaxis (AP) is recommended to reduce postoperative urinary tract infections. So far, no international recommendations for AP have been established for GL. In a survey-based study in Switzerland, Germany and Austria, urologists reported routinely extending AP primarily for 3 days after both interventions. We therefore aim to determine whether single-dose AP with cotrimoxazole is non-inferior to 3-day AP with cotrimoxazole in patients undergoing TURP or GL of the prostate. Methods/design We will conduct an investigator-initiated, multicentre, randomised controlled trial. We plan to assess the non-inferiority of single-dose AP compared to 3-day AP. The primary outcome is the occurrence of clinically diagnosed symptomatic urinary tract infections which are treated with antimicrobial agents within 30 days after randomisation. The vast majority of collected outcomes will be assessed from routinely collected data. The sample size was estimated to be able to show the non-inferiority of single-dose AP compared to 3-day AP with at least 80% power (1 – β = 0.8) at a significance level of α = 5%, applying a 1:1 randomisation scheme. The non-inferiority margin was determined in order to preserve 70% of the effect of usual care on the primary outcome. For an assumed event rate of 9% in both treatment arms, this resulted in a non-inferiority margin of 4.4% (i.e. 13.4% to 9%). To prove non-inferiority, a total of 1574 patients should be recruited, in order to have 1416 evaluable patients. The study is supported by the Swiss National Science Foundation. Discussion For AP in TURP and GL, there is a large gap between usual clinical practice and evidence-based guidelines. If single-dose AP proves non-inferior to prolonged AP, our study findings may help to reduce the duration of AP in daily routine—potentially reducing the risk of emerging resistance and complications related to AP. Trial registration Clinicaltrials.gov, NCT03633643 . Registered 16 August 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3237-3) contains supplementary material, which is available to authorized users.

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Overuse of antimicrobial prophylaxis in low-risk patients undergoing transurethral resection of the prostate

Abstract: A low adherence to guidelines for low-risk patients undergoing TURP or PVP was reported. Given these preliminary data, there is an urgent need to monitor adherence to antimicrobial prophylaxis guidelines in urology to reduce antimicrobial resistance rates.

Cited by 8 publications

References 0 publications

Adherence to European Association of Urology Guidelines and State of the Art of Glycosaminoglycan Therapy for the Management of Urinary Tract Infections: A Narrative Review and Expert Meeting Report

Adherence to European Association of Urology Guidelines and State of the Art of Glycosaminoglycan Therapy for the Management of Urinary Tract Infections: A Narrative Review and Expert Meeting Report

Assessment of Guideline Discordance With Antimicrobial Prophylaxis Best Practices for Common Urologic Procedures

Single-dose versus 3-day cotrimoxazole prophylaxis in transurethral resection or greenlight laser vaporisation of the prostate: study protocol for a multicentre randomised placebo controlled non-inferiority trial (CITrUS trial)

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