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1476. The Role of Empirical Antibiotics Determined by Pre-procedural Urinalysis and Urine Cultures in Elective Urological Interventions
BACKGROUND: At a urology center in Australia, patients undergoing elective nonurgent urological surgery routinely receive empirical antibiotic treatment based on urinalysis (UA) prior to intervention to treat presumptive bacteriuria. Sterilization of urine with empirical antibiotics in procedures in...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6810336/ http://dx.doi.org/10.1093/ofid/ofz360.1340 |
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author | Smith, Georgia Chung Kay, Patrick Catterwell, Rick Nelson, Renjy Warner, Morgyn |
author_facet | Smith, Georgia Chung Kay, Patrick Catterwell, Rick Nelson, Renjy Warner, Morgyn |
author_sort | Smith, Georgia |
collection | PubMed |
description | BACKGROUND: At a urology center in Australia, patients undergoing elective nonurgent urological surgery routinely receive empirical antibiotic treatment based on urinalysis (UA) prior to intervention to treat presumptive bacteriuria. Sterilization of urine with empirical antibiotics in procedures involving stone manipulation and mucosal disruption in the genitourinary system has been shown to reduce infection risks but whether this translates to low-risk urological interventions is not clear. METHODS: Patients undergoing outpatient elective urological procedures during a 3-month period between September and November 2017 were retrospectively reviewed. Patient demographics, results of urinalyses, empirical antibiotic use, and data surrounding post-intervention complications were collected and reviewed. Results were analyzed using SPSS v 25. RESULTS: Of 119 patients, 111 underwent a pre-procedure urinalysis. Fifty-eight percent (n = 64) of patients were treated with empiric antibiotics pre-operatively based on a positive UA (defined as the presence of urinary leukocytes or nitrites). Fifty-five percent (n = 41) of patients who received empirical antibiotics returned a positive urine culture, and only 49 percent (n = 20) of those receiving antibiotics cultured organisms susceptible to initial antibiotics prescribed. 1 Death, 3 incidences of bacteremia, and 10 incidences of bacteriuria up to 2 weeks occurred post-intervention in this cohort. There was no discernible risk of adverse events based on a composite of post-intervention death, bacteremia and bacteriuria in patients with a positive pre-procedural UA (n = 67/111, RR0.67 CI 0.49–0.91, P = 0.10). Pre-procedural sterilized urine similarly did not demonstrated any reduced risk of post-intervention adverse outcomes (n = 77/119, RR1.02 CI 0.64–1.63, P = 0.94). CONCLUSION: This study demonstrated no increased risk of post-operative infection in patients with a positive urinalysis or urine culture with bacteriuria prior to intervention. There was a high use of broad-spectrum antibiotic as a reflex to positive urinalyses alone highlighting an avenue for improved anti-microbial stewardship. More research is needed to guide clinicians on the role of urine cultures and antibiotics prior to non-urgent urological procedures. DISCLOSURES: All authors: No reported disclosures. |
format | Online Article Text |
id | pubmed-6810336 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-68103362019-10-28 1476. The Role of Empirical Antibiotics Determined by Pre-procedural Urinalysis and Urine Cultures in Elective Urological Interventions Smith, Georgia Chung Kay, Patrick Catterwell, Rick Nelson, Renjy Warner, Morgyn Open Forum Infect Dis Abstracts BACKGROUND: At a urology center in Australia, patients undergoing elective nonurgent urological surgery routinely receive empirical antibiotic treatment based on urinalysis (UA) prior to intervention to treat presumptive bacteriuria. Sterilization of urine with empirical antibiotics in procedures involving stone manipulation and mucosal disruption in the genitourinary system has been shown to reduce infection risks but whether this translates to low-risk urological interventions is not clear. METHODS: Patients undergoing outpatient elective urological procedures during a 3-month period between September and November 2017 were retrospectively reviewed. Patient demographics, results of urinalyses, empirical antibiotic use, and data surrounding post-intervention complications were collected and reviewed. Results were analyzed using SPSS v 25. RESULTS: Of 119 patients, 111 underwent a pre-procedure urinalysis. Fifty-eight percent (n = 64) of patients were treated with empiric antibiotics pre-operatively based on a positive UA (defined as the presence of urinary leukocytes or nitrites). Fifty-five percent (n = 41) of patients who received empirical antibiotics returned a positive urine culture, and only 49 percent (n = 20) of those receiving antibiotics cultured organisms susceptible to initial antibiotics prescribed. 1 Death, 3 incidences of bacteremia, and 10 incidences of bacteriuria up to 2 weeks occurred post-intervention in this cohort. There was no discernible risk of adverse events based on a composite of post-intervention death, bacteremia and bacteriuria in patients with a positive pre-procedural UA (n = 67/111, RR0.67 CI 0.49–0.91, P = 0.10). Pre-procedural sterilized urine similarly did not demonstrated any reduced risk of post-intervention adverse outcomes (n = 77/119, RR1.02 CI 0.64–1.63, P = 0.94). CONCLUSION: This study demonstrated no increased risk of post-operative infection in patients with a positive urinalysis or urine culture with bacteriuria prior to intervention. There was a high use of broad-spectrum antibiotic as a reflex to positive urinalyses alone highlighting an avenue for improved anti-microbial stewardship. More research is needed to guide clinicians on the role of urine cultures and antibiotics prior to non-urgent urological procedures. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6810336/ http://dx.doi.org/10.1093/ofid/ofz360.1340 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Abstracts Smith, Georgia Chung Kay, Patrick Catterwell, Rick Nelson, Renjy Warner, Morgyn 1476. The Role of Empirical Antibiotics Determined by Pre-procedural Urinalysis and Urine Cultures in Elective Urological Interventions |
title | 1476. The Role of Empirical Antibiotics Determined by Pre-procedural Urinalysis and Urine Cultures in Elective Urological Interventions |
title_full | 1476. The Role of Empirical Antibiotics Determined by Pre-procedural Urinalysis and Urine Cultures in Elective Urological Interventions |
title_fullStr | 1476. The Role of Empirical Antibiotics Determined by Pre-procedural Urinalysis and Urine Cultures in Elective Urological Interventions |
title_full_unstemmed | 1476. The Role of Empirical Antibiotics Determined by Pre-procedural Urinalysis and Urine Cultures in Elective Urological Interventions |
title_short | 1476. The Role of Empirical Antibiotics Determined by Pre-procedural Urinalysis and Urine Cultures in Elective Urological Interventions |
title_sort | 1476. the role of empirical antibiotics determined by pre-procedural urinalysis and urine cultures in elective urological interventions |
topic | Abstracts |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6810336/ http://dx.doi.org/10.1093/ofid/ofz360.1340 |
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