883. Evaluation of Post-operative Antibiotic Prophylaxis in Patients Undergoing Urologic Procedures

BACKGROUND: Many national guidelines do not recommend post-operative antibiotic prophylaxis due to lack of literature supporting its use; however, they are frequently prescribed at ChristianaCare for urologic procedures. Use of post-operative antibiotics has not correlated with reduction in post-operative infections, and has been show to increase risk for resistant infections, Clostridiodes difficile (C. difficile) and acute kidney injury (AKI). METHODS: A single center retrospective chart review was conducted to evaluate endpoints of patients who underwent a urologic procedure and received post-operative antibiotics (intervention group) compared to those who did not (control group) from June 1(st) 2018 to September 1(st) 2019. The primary endpoint was to compare the incidence of post-operative infections, including surgical site infections (SSIs), bacteremia, and urinary tract infections (UTIs) between the intervention and control groups. The secondary endpoints included comparing the incidence of prespecified adverse outcomes, between the two groups. RESULTS: A total of 250 patients were included in this study. Baseline demographics were similar across a number of characteristics in both groups. There was no difference between the intervention and control groups in the incidence of post-operative bacteremia (p = 0.608), SSIs (p = 0.491) and 30 day UTIs (p = 0.307). The rate of AKI between both groups were similar. There was a higher percentage of resistant organisms seen in the intervention group compared to the control group (21.4 % vs. 16.7%). The intervention group experienced an increase in post-operative antibiotic related adverse effects. Although a small number of patients were tested for C. difficile, there was one positive C. difficile PCR in the intervention group compared to zero in the control group. CONCLUSION: The results of this study support withholding post-operative antibiotics in urologic procedures given no benefit in reducing post-operative infections and potential to increase adverse effects and development of resistant organisms. Efforts to change this current practice at our institution will be implemented via collaboration with the urology section and review of current order sets. DISCLOSURES: Jillian Laude, Pharm D, BCPS, Shionogi Inc (Other Financial or Material Support, Received one-time speaker fee for a round table discussion. The financial relationship does not relate to this research project.)