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

Carey, Michelle; Zreik, Abdullah; Fenn, Neil; Chłosta, Piotr; Aboumarzouk, Omar

doi:10.1159/000381882

Cited by 17 publications

(13 citation statements)

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“…They found a rate of UTIs in the intervention group of 0.7 % and 3 % in the placebo group, the authors concluded that no significant differences were found. A Systematic Review and Meta-Analysis from Carey et al, 7 including all the randomized control trials on prophylactic antibiotic use for flexible cystoscopy, reported that AP has decreased the cases of symptomatic and asymptomatic bacteriuria but with a high number need to treat. Therefore, the authors cannot advocate the use of antibiotic prophylaxis for routine cystoscopies.…”

Section: Discussionmentioning

confidence: 99%

Flexible cystoscopy for ureteral stent removal without antimicrobial prophylaxis. A prospective observational study

et al. 2020

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Objective: Flexible cystoscopy for ureteral stent removal after ureteroscopy is widely performed. In this scenario, the real need for antimicrobial prophylaxis is still uncertain. Aim of this study is to determine the urinary tract infections rate after 4 weeks from outpatient flexible cystoscopies for ureteral stent removal without antimicrobial prophylaxis. Patients and methods: A prospective observational study was performed between November 2017 and August 2018 in a single, high-volume Institution. Risk factors for UTIs were recorded. Immediately before cystoscopy, each patient submitted a voided urine specimen. Antibiotics were not given before or after cystoscopy. About 7 and 28 days after cystoscopy all the patients underwent abdomen US, urine analysis and culture, and clinical evaluation to assess possible symptoms of UTI. Results: A total of 192 patients were enrolled in the study, 76 patients (39.2%) were female. Median age was 55 years [IQR 47- 68]. Median BMI was 24.2 [22.9-26.7]. Eighteen patients (9.4%) had asymptomatic bacteriuria before cystoscopy and 39 (20.3%) had positive culture at 7 days. About 21 patients (10.9%) were diagnosed with febrile UTI in the 28 days FU period. The 28.6 % of the Febrile patients had asymptomatic bacteriuria before the stent removal ( p < 0.001), this group was slightly older ( p = 0.085) and with higher BMI ( p = 0.036). Forty-eight patients had positive urine culture at 7 days, of whom 27 (14.1%) were asymptomatic and were classified as asymptomatic bacteriuria. Multivariate analysis shows that only high BMI and bacteriuria before the procedure were significantly associated with developing a febrile UTI, none of the other risk factors was significant. Conclusion: Our data show a high rate of UTI after flexible cystoscopies for ureteral stent removal without antimicrobial prophylaxis especially in patients with asymptomatic bacteriuria, in those with high BMI and in the elderly; in these subgroups, antimicrobial prophylaxis should be recommended.

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Section: Discussionmentioning

confidence: 99%

Flexible cystoscopy for ureteral stent removal without antimicrobial prophylaxis. A prospective observational study

et al. 2020

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“…La mayoría de los estudios sobre quimioprofilaxis utilizan las Fluoroquinolonas o el TMP-SMX, y en menor medida la Cefalosporinas como antibiótico de elección. 6,23 Existen pocos estudios en los que utilicen la FT 3 g como profilaxis antes de la cistoscopia. Los más destacados de Nicoletti y col. 19 y el de Jiménez-Pacheco y col., 12 presentan una muestra inferior y solo Periti y col. 24 con 283 pacientes se aproxima a la nuestra, pero el suyo no era un estudio randomizado e incluía profilaxis en pacientes que iban a ser sometidos a resección transuretral.…”

Section: Discussionunclassified

“…Uno de los debates que suscitan siempre esos estudios, es determinar si las bacteriurias significativas postcistoscopias se consideran ITU que pueden requerir un tratamiento antibiótico, o si son meras bacteriurias asintomáticas las cuales no precisan de más actuación. 6,23 Para poder diferenciarlas, en nuestro estudio se les avisó telefónicamente a los pacientes para saber si tuvieron síntomas urinarios tras la realización de la cistoscopia flexible, duración de los mismos y si fue necesaria actuación médica. Y se definió como ITU la presencia de bacteriuria significativa junto con la presencia de síntomas urinarios.…”

Section: Discussionunclassified

“…Sin embargo, hay ensayos en los cuales no se determina con un cultivo previo a la cistoscopia flexible la presencia de bacteriuria significativa o de síntomas del tracto urinario. 23 En nuestro estudio, para poder determinar las verdaderas nuevas ITU tras la realización de la cistoscopia, se les realizó un urinocultivo previo a la cistoscopia y se les hizo una encuesta sobre la presencia de síntomas urinarios, y no se contabilizaron aquellos pacientes con criterios de ITU postcistoscopia que presentaban criterios de ITU previos a la cistoscopia.…”

Section: Discussionunclassified

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Evaluación de la eficacia de fosfomicina trometamol y gentamicina en la profilaxis de la cistoscopia flexible tras el estudio de los patógenos de nuestro entorno

et al. 2018

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Palabras Clave► profilaxis ► cistoscopia ► fosfomicina trometamol ► gentamicina ► infección del tracto urinario ► antibiótico ResumenObjetivo Optimizar el uso de antibióticos en la profilaxis de la cistoscopia flexible estudiando los patógenos más frecuentes de nuestro entorno y eligiendo el antibiótico según sus antibiogramas. Métodos Desde Enero del 2015 hasta Noviembre del 2015, se analizaron los urinocultivos de nuestra área, se eligió el antibiótico en función a su sensibilidad frente a los patógenos más frecuentes y se comparó con un antibiótico de amplio espectro. Desde Enero del 2016 hasta Diciembre del 2016, se realizaron las cistoscopias agrupando a los pacientes en: Grupo 1: Pacientes sin profilaxis; Grupo 2: Profilaxis con Gentamicina 240 mg; Grupo 3: Profilaxis con antibiótico seleccionado. Como variables principales se definieron la presencia de bacteriuria asintomática e ITU tras la realización de la cistoscopia flexible. Resultados Se analizaron 8.530 urinocultivos y se eligió la Fosfomicina Trometamol 3 gr como profilaxis. Se realizaron 244 cistoscopias distribuidas: Grupo 1: 86 (35%); Grupo 2: 72 (30%); Grupo 3: 86 (35%). Se detectó bacteriuria asintomática postcistoscopia en 6 pacientes (2,5%) en el Grupo 1, 7 pacientes (2,9%) en el grupo 2 y 5 pacientes (2%) en el grupo 3 no presentando diferencias significativas (p 0.120). Desarrollaron ITUs postcistoscopia 1 paciente (0,4%) en el Grupo 1, 5 pacientes (2%) en el Grupo 2 y 2 pacientes (0,8%) en el Grupo 3 sin diferencias significativas (p 0.105). Conclusión La Fosfomicina es tan efectiva como la Gentamicina en la profilaxis de la cistoscopia. Para un uso correcto de los antibióticos, se recomienda el estudio de los patógenos de nuestro entorno.

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“…Results from multiple randomized controlled trials indicate antimicrobial prophylaxis is effective in reducing post‐procedure bacteriuria but may not significantly impact UTI risk . A recent meta‐analysis concluded that 32 patients undergoing cystoscopy must be given prophylaxis to prevent one clinical UTI .…”

Section: Introductionmentioning

confidence: 99%

Safety and effectiveness of zero antimicrobial prophylaxis protocol for outpatient cystourethroscopy

2019

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Objectives To examine compliance and clinical outcomes after implementation of a zero antimicrobial prophylaxis protocol for outpatient cystoscopy in an academic centre. Patients and Methods Medical records of all patients who underwent diagnostic cystoscopy in the year preceding and year following protocol implementation were evaluated for urinary tract infection (UTI) diagnosis within 30 days of cystoscopy. Variables compared between groups included age, sex, smoking history, benign prostatic hyperplasia (BPH) diagnosis, diabetes mellitus, immunosuppression, catheter use (indwelling, suprapubic, or intermittent), and previous lower urinary tract reconstruction (augmentation cystoplasty or neobladder). UTI was defined using the National Surgical Quality Improvement Program definition. Rates were compared between groups, and statistical analyses were performed using chi‐squared and Fisher's exact tests and multivariable logistic regression, with significance defined as α < 0.05. Results In total, 941 patients were included in the analysis (72% men), 513 before protocol initiation, and 427 after. Groups were similar with regard to demographic variables and potential risk factors for infection. After protocol implementation, there was a significant reduction in patients receiving procedural antimicrobial prophylaxis (30% vs 15%; P < 0.001). The incidence of UTI after cystoscopy was slightly higher in the post‐protocol group (2.9–3.7%), but the difference was not statistically significant (chi‐squared = 0.56, P = 0.45). The incidence of UTI did not significantly differ with procedural antibiotic prophylaxis or with other antibiotic use at time of cystoscopy. Five out of a total of 31 UTIs (16%) over the study period resulted in fever, and four (13%) resulted in urosepsis. The probability of neither complication differed significantly between pre‐ and post‐protocol groups. The only significant patient‐level predictor of post‐cystoscopy UTI was catheter use (odds ratio 1.48, 95% confidence interval 1.06–2.06). Conclusion Protocol implementation led to a significant decrease in procedural antimicrobial prophylaxis, indicating protocols may be effective tools in promoting antibiotic stewardship. UTI incidence did not change significantly under the protocol, and antibiotic prophylaxis did not decrease infection rate. Our results support catheter use as a risk factor for post‐cystoscopy infection, but other patient variables, including those present in the American Urological Association Best Practice statement, were not predictive. In total, this analysis suggests that decreasing antibiotic prophylaxis for cystourethroscopy is safe and can be effective in the outpatient setting.

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

Cited by 17 publications

References 20 publications

Flexible cystoscopy for ureteral stent removal without antimicrobial prophylaxis. A prospective observational study

Flexible cystoscopy for ureteral stent removal without antimicrobial prophylaxis. A prospective observational study

Evaluación de la eficacia de fosfomicina trometamol y gentamicina en la profilaxis de la cistoscopia flexible tras el estudio de los patógenos de nuestro entorno

Safety and effectiveness of zero antimicrobial prophylaxis protocol for outpatient cystourethroscopy

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