A Randomized Controlled Trial to Study the Rationale of Antibiotic Prophylaxis in Diagnostic Rigid Cystoscopy: A Relook in The Era of Antibiotic Stewardship

BACKGROUND: In the era of widespread antibiotic (AB) resistance, the role of prophylaxis in diagnostic cystoscopy is controversial. AIM: This study aimed to compare the incidence of postcystoscopy positive urinary culture (PC-PUC) and urinary tract infection (UTI) in patients undergoing diagnostic rigid cystoscopy with and without prophylaxis with preprocedural single-dose intravenous AB. MATERIALS AND METHODS: This prospective study was done in patients with preprocedural sterile urine undergoing elective diagnostic rigid cystoscopy. Patients were randomized into two groups, with one group receiving preprocedure single dose of intravenous cefuroxime sodium as prophylaxis half to 1 h before the procedure (Group AB prophylaxis) and the other group receiving no antibiotic prophylaxis (Group NAB). All patients were followed up till 1-month postprocedure, for any symptoms of urinary infection, mandatory urine microscopy and culture at 24–48 h, 1 week and 4 weeks post procedure, and addition sample in case of any urinary symptoms or fever. RESULTS: A total of 225 patients were studied, with 110 in AB prophylaxis and 115 in NAB groups. The use of prophylaxis did not decrease the incidence of PC-PUC (8.7%–3.6%; P = 0.167) or UTI (6.1%–1.8%; P = 0.102). Females and diabetics had significantly higher risk of PC-PUC, on univariate and multivariate analysis, not affected by prophylaxis. CONCLUSION: Preprocedural AB prophylaxis does not decrease the incidence of postcystoscopy bacteriuria significantly. Females and diabetics have significantly increased risk, but prophylaxis has no role in them either.