MP02-04 ANTIBIOTIC STEWARDSHIP FOR AMBULATORY UROLOGIC PROCEDURES: CYSTOSCOPY AND VASECTOMY

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety I1 Apr 2018MP02-04 ANTIBIOTIC STEWARDSHIP FOR AMBULATORY UROLOGIC PROCEDURES: CYSTOSCOPY AND VASECTOMY Mark Henry, Dattatraya Patil, Christopher Filson, and Akanksha Mehta Mark HenryMark Henry More articles by this author , Dattatraya PatilDattatraya Patil More articles by this author , Christopher FilsonChristopher Filson More articles by this author , and Akanksha MehtaAkanksha Mehta More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.130AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We sought to evaluate physician adherence to the AUA Best Practice Statement on antimicrobial prophylaxis, in order to assess physician interest in antibiotic stewardship. Pre-procedural prophylactic antibiotics are not routinely recommended for uncomplicated cystoscopy and vasectomy, given the low risk of infection associated with these commonly performed procedures. METHODS We used 2009-2015 Truven Health MarketScan Data to identify men who underwent either diagnostic cystoscopy or vasectomy using CPT 52000 and CPT55250/V2652 codes, respectively. Antibiotics associated with a procedure were captured within a 30-day pre-procedural window for oral, and 24 hour pre-procedural window for parenteral medication, respectively. Antibiotics were identified using National Drug Code numbers submitted for pharmaceutical & outpatient service claims. We assessed relevant patient characteristics (age, Charlson Comorbidity Index (CCI), U.S. Census Bureau region, year of procedure, health plan type, and metropolitan service area) that could potentially impact antibiotic use. Trends in antibiotic use, and the impact of covariates on antibiotics use was determined using linear regression models with SAS v9.4 software. Significance was set as two-tailed p-values <0.05. RESULTS 1,060,199 cystoscopy and 433,013 vasectomy claims were processed during the study period. Prophylactic antibiotics were utilized in 38% of all cystoscopies and 16% of all vasectomies. Antibiotic use increased throughout the study period for both cystoscopy (34.9% to 45.2%, p = 0.002) and vasectomy (15.8% to 19.5%, p = 0.032). Increasing age and CCI were associated with decreased likelihood of prophylactic antibiotics for cystoscopy, while increasing age and CCI were associated with an increased likelihood of prophylactic antibiotics for vasectomy. Geographic region was also found to impact the likelihood of antibiotic use; with Northcentral as the reference point, antibiotic use for both cystoscopy and vasectomy was highest is the South (OR 1.21 and 1.44, respectively), and lowest in the Northeast for cystoscopy (OR 0.85) and West for vasectomy (OR 0.89) (p < 0.001). CONCLUSIONS Despite evidence-based recommendations against routine prophylactic antibiotics for uncomplicated office procedures like cystoscopy and vasectomy, antibiotic use has nevertheless increased overtime, with implications for antibiotic resistance and changes in normal microbial flora. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e12-e13 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Mark Henry More articles by this author Dattatraya Patil More articles by this author Christopher Filson More articles by this author Akanksha Mehta More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...