UPJ INSIGHT Does Antimicrobial Prophylaxis in Patients with Specific Comorbidities Reduce the Risk of Infection after Simple Cystourethroscopy?

By: Brenton G. Sherwood, MD; Elizabeth B. Takacs, MD; Bradley A. Ford, MD, PhD; Sarah L. Mott, MS; Bradley T. Loeffler, MS; Gina M. Lockwood, MD | Posted on: 01 Oct 2022

Sherwood BG, Takacs EB, Ford BA, Mott SL, Loeffler BT, Lockwood GM. Does antimicrobial prophylaxis in patients with specific comorbidities reduce the risk of infection after simple cystourethroscopy? Urol Pract. 2022;9(5)414-422.

Study Need and Importance

The current AUA Best Practice Statement for antimicrobial prophylaxis (AP) generally does not recommend AP for simple office cystourethroscopy, but also references a large list of comorbidities and risk factors that may increase the risk of post-procedural infection (PPI) which may be used to encourage AP for these patients. However, this list of risk factors is not specific to cystourethroscopy, and evidence that AP reduces the risk of infection after cystourethroscopy for patients with these risk factors is limited. The purpose of our study was to evaluate many of these risk factors to determine whether AP decreases the rate of infection after simple office cystourethroscopy.

Table. Odds ratios for developing PPI based on whether AP was given for each comorbidity group

Comorbidity Received AP? Odds Ratio for Developing PPI* 95% CI P-value**
Advanced Age (≥ 75 years) Y 1.00 0.51 1.94 0.76
N 1.14 0.51 2.56
Diabetes Y 1.45 0.74 2.83 0.55
N 1.11 0.49 2.50
Chronic obstructive pulmonary disease Y 1.56 0.63 3.89 0.25
N 0.81 0.24 2.75
Malnutrition Y 4.79 1.71 13.44 0.84
N 4.19 1.23 14.23
Immunodeficiency Y 4.06 1.92 8.58 0.38
N 2.55 0.97 6.69
Current Smoker Y 0.51 0.17 1.57 0.83
N 0.61 0.16 2.30
Upper Tract Anatomic Anomaly Y 1.86 0.64 5.44 0.06
N 5.81 2.51 13.43
Cardiovascular Disease Y 0.97 0.43 2.19 0.90
N 1.03 0.41 2.54
Female Gender (compared to Male) Y 2.26 1.24 4.13 0.94
N 1.92 0.94 3.95
*Each odds ratio represents the odds of developing a PPI in a group of patients who have the listed comorbidity and either received or did not receive AP, as indicated.
**The p value represents the significance of the difference between the odds ratios for AP vs no AP for each comorbidity.

What We Found

Overall, AP decreased the rate of post-procedural infection (OR 0.51, 95% CI 0.35-0.76; p<0.01), though the overall rate of post-procedural infection was low (0.9%) and the number needed to treat to prevent 1 infection was 100. None of the comorbidities evaluated showed significant benefit from AP for prevention of post-procedural infection (see Table).

Limitations

Our data were collected via Epic® reporting software that queried data from our single-hospital system and therefore did not include patients who may have been diagnosed with an infection after cystourethroscopy by a provider outside our hospital system. Our analysis is also limited by the low number of post-cystourethroscopy infections, which may have limited our ability to detect clinically significant effects of AP for some comorbidities.

Interpretation for Patient Care

Our data support the AUA Best Practice Statement to not recommend AP for simple office cystourethroscopy in the absence of signs or symptoms of an active urinary tract infection. Our findings suggest that the comorbidities evaluated in our study should not be used to recommend AP for patients undergoing simple office cystourethroscopy.

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