Antimicrobial agents for preventing urinary tract infections in adults undergoing cystoscopy

Zeng, Shuxiong; Zhang, Zhensheng; Bai, Yu; Sun, Yinghao; Xu, Chuanliang

doi:10.1002/14651858.cd012305.pub2

Cited by 10 publications

(11 citation statements)

References 59 publications

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“…However, the current guidelines for antibiotic prophylaxis for cystoscopy are based on studies of mostly male patients when it is known that women are far more likely to develop UTIs than men 5 . Zeng et al 2 performed a systematic review investigating antibiotic prophylaxis for the prevention of UTI after cystoscopy. The review included 20 randomized controlled trials and 2 quasi-randomized controlled trials.…”

Section: Discussionmentioning

confidence: 99%

“…Urodynamic studies (UDS) and cystoscopy are frequently performed in the evaluation and treatment of female lower urinary tract dysfunction within a urogynecology practice. Urinary tract infection (UTI) is the most common complication after UDS and a known complication of cystoscopy 1,2 . A recent survey of the American Urogynecologic Society membership demonstrated that in the setting of UDS, 33% of respondents prescribed antibiotic prophylaxis to high risk patients, 14% prescribed antibiotic prophylaxis to all patients, whereas the remaining half never prescribed antibiotic prophylaxis.…”

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confidence: 99%

“…Urinary tract infection (UTI) is the most common complication after UDS and a known complication of cystoscopy. 1,2 A recent survey of the American Urogynecologic Society membership demonstrated that in the setting of UDS, 33% of respondents prescribed antibiotic prophylaxis to high risk patients, 14% prescribed antibiotic prophylaxis to all patients, whereas the remaining half never prescribed antibiotic prophylaxis. For cystoscopy, 58% of the respondents prescribed antibiotic prophylaxis to either all patients or high-risk patients.…”

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confidence: 99%

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A Retrospective Cohort Study to Identify the Risk Factors for Urinary Tract Infection After Office Procedures

Jackson

Ackerman²,

Alesna³

et al. 2022

Female Pelvic Med Reconstr Surg

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ObjectiveThe objective of this study is to identify the incidence of and risk factors for urinary tract infection (UTI) after office cystoscopy and urodynamic studies (UDS) in a female population.MethodsThis was a retrospective cohort study investigating incidence of and risk factors for UTI after office testing. Inclusion criteria included women presenting for either cystoscopy or UDS from September 2019 to February 2020. Modified Poisson regression with robust error variance was used to identify risk factors for UTI after cystoscopy and UDS in a female population.ResultsA total of 274 patients met inclusion criteria. One hundred eighty-five patients underwent office cystoscopy. Nine (4.8%) had a postcystoscopy UTI. Significant risk factors for postcystoscopy UTI included recurrent UTI (relative risk, 7.51; 95% confidence interval, 1.66–34.05) and a history of interstitial cystitis (relative risk, 4.56; 95% confidence interval, 1.52–13.73). Of those with recurrent UTI, 13.7% had a postcystoscopy UTI. Among patients with interstitial cystitis, 25% had a postcystoscopy UTI. One hundred ninety-two patients underwent UDS. Ten (5.2%) developed a post-UDS UTI. No risk factors were identified.ConclusionsPatients with recurrent UTI were 7.51 times more likely to develop a UTI after cystoscopy, whereas those with interstitial cystitis were 4.56 times more likely to develop a UTI after cystoscopy. The incidence of UTI after UDS was low overall. Understanding who is at higher risk of postprocedural UTIs may help identify subpopulations that may benefit from prophylactic strategies.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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A Retrospective Cohort Study to Identify the Risk Factors for Urinary Tract Infection After Office Procedures

Jackson

Ackerman²,

Alesna³

et al. 2022

Female Pelvic Med Reconstr Surg

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“…More recently, a Cochrane intervention review was published. 8 The paper included 20 RCTs and two quasi-RCTs with 7711 participants with the conclusions that antibiotics given for UTI prevention before cystoscopy may have little effect on the risk of developing serious infection, however, the quality of the evidence was rated low or very low. Similar studies conducted, to evaluate the potential benefit of AP before Transurethral Resection of the Bladder (TURB), concluded that antimicrobial prophylaxis could be safely avoided prior to TURB, in patients without pre-existing risk factors for UTIs.…”

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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“…In the context of minimal knowledge on standard infection rates, and the difficulty in establishing practice-based rates due to patients seeking UTI treatments from different practitioners outside of their urogynecologist or urologist, these recommendations provide little guidance. Of note, a recent update of the Cochrane review on antibiotic prophylaxis for cystoscopy only indicated that antibiotic prophylaxis may reduce UTI [8].…”

Section: Introductionmentioning

confidence: 99%

Use of Prophylactic Antibiotics to Prevent Urinary Tract Infection after Urodynamic Testing and Cystoscopy in Women: A Practice Pattern Study

Benseler

McDermott

2022

Gynecol Obstet Invest

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Objectives: To determine practice patterns of prescribing prophylactic antibiotics against urinary tract infection (UTI) for urodynamic studies (UDS) and outpatient cystoscopy in women. Design: A cross-sectional survey study was conducted of North American female pelvic medicine and reconstructive specialists (FPMRS). Methods: An online survey was used to assess prophylactic prescribing patterns of FPMRS specialists that perform UDS and outpatient cystoscopy. This survey was developed and then electronically disseminated through the American Urogynecologic Society to 699 eligible physicians. Results: A total of 138 surveys were completed. Approximately half of physicians did not prescribe any antibiotic prophylaxis for UDS or for cystoscopy (54% and 43%, respectively). For patients with perceived risk factors (recurrent urinary tract infections, immunosuppression, known neurogenic lower urinary tract dysfunction, indwelling catheter use, elevated post void residual/bladder outlet obstruction, genitourinary anomalies, and diabetes), 32% and 41% of physicians prescribed antibiotic prophylaxis for UDS and cystoscopy, respectively. A minority of physicians always prescribed antibiotics for UDS and cystoscopy (13% and 17%, respectively). Limitations: The response rate was a limitation of the study, however, this rate is in keeping with other physician survey studies published within this subspecialty. Selection and response biases may have contributed to the results of this survey study. Conclusion: There was no uniform approach to urinary tract infection prophylaxis for UDS and outpatient cystoscopy in women which reflects the lack of current guidelines and the low level of evidence on which they are based. This non-uniform practice calls for more research to better define an evidence-based standard of care.

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Antimicrobial agents for preventing urinary tract infections in adults undergoing cystoscopy

Cited by 10 publications

References 59 publications

A Retrospective Cohort Study to Identify the Risk Factors for Urinary Tract Infection After Office Procedures

A Retrospective Cohort Study to Identify the Risk Factors for Urinary Tract Infection After Office Procedures

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

Use of Prophylactic Antibiotics to Prevent Urinary Tract Infection after Urodynamic Testing and Cystoscopy in Women: A Practice Pattern Study

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