1033 Is preoperative UTI associated with increased risks of UTI after ureteroscopic lithotripsy? A nationwide population-based study

Abstract

INTRODUCTION AND OBJECTIVES: The AUA offers Best Practice recommendations for antimicrobial prophylaxis for urologic surgeries. Despite these recommendations, the duration and class of antibiotics administered by urologists varies considerably. Improper administration of antibiotics may lead to increased costs, antibiotic resistance, predispose to hospital-acquired infections, and induce adverse drug reactions. We examined index urologic procedures and assessed compliance with AUA guidelines for antibiotic class and duration. METHODS: From the Premier Perspectives Database, we identified 53,450 patients undergoing radical prostatectomy (RP), 4,732 undergoing radical cystectomy (RC), 44,133 undergoing partial or radical nephrectomy (Nephx), 202,740 undergoing ureteroscopy/shock wave lithotripsy (SWL), 91,279 undergoing transurethral resection of the prostate (TURP), 21,469 undergoing percutaneous nephrostolithotomy (PCNL), 54,908 undergoing transvaginal surgery, 8,612 undergoing penile prosthesis (IPP), 11,487 patients undergoing brachytherapy, and 114,132 undergoing transurethral resection of bladder tumors (TURBT), based on ICD-9 procedure codes, from 2007-2012. Antibiotic class and duration were abstracted from patient billing data. Overall compliance with the AUA Best Practice Policy Statement was defined as receiving the appropriate antibiotic class (or antibiotic class combination) in conjunction with duration not extending beyond 24 hours post-surgery as detailed in the AUA Best Practice Policy Statement. RESULTS: Surgery-specific rates of compliance with AUA guidelines for selected procedures are listed in the Table. Correct antibiotic class was ordered in 67% of cases (range 34-80% for the different procedures). The correct duration (<24 hours post-surgery) was observed in 78% of cases overall (range 1.2-98%). Average length of antibiotic prophylaxis ranged from 1.1 days after brachytherapy to 10.3 days following RC. Overall compliance was 53.4%, ranging from 0.6% in RC to 68.3% in ESWL. Over time, compliance increased, ranging from a low of 46.2% overall compliance in 2007 to 58.9% overall compliance in 2012. CONCLUSIONS: The administration of antibiotic prophylaxis after surgery is subject to considerable variation. Increased compliance in recent years may relate to better dissemination of AUA guidelines. Efforts are needed to further improve standardization of antibiotic administration for common urologic procedures.