MP35-07 ANTIBIOTIC USAGE IN URETHROPLASTIES

Abstract

INTRODUCTION AND OBJECTIVE: There are no established guidelines regarding management of antibiotics for patients specifically undergoing urethroplasty, which has resulted in significant variation in practice with type, duration, and timing of antibiotic usage. Our aim was to minimize antibiotic use by following a standardized protocol in the pre, peri and post-operative setting and adhere to AUA antibiotic guidelines for urethroplasty. We hypothesized that the common practice of prolonged suppressive antibiotics post urethroplasty does not prevent UTI and/or wound infection rates. METHODS: We prospectively treated 900 patients undergoing urethroplasty at 11 centers over 2 years. A standardized protocol followed the AUA guidelines recommendation for peri-operative cephalosporins eliminating the over use of more board spectrum antibiotics. Phase 1 of our study assessed current practice patterns amongst surgeons in the Trauma and Urologic Reconstruction Network of Surgeons (TURNS) and established a baseline UTI and wound infection rates on suppressive antibiotics. Phase 2 eliminated prolonged post-operative suppressive antibiotics. Antibiotics were given at catheter removal. 30-day infectious complications were determined and a chi-square analysis was used to compare the two cohorts. A standardized definition of UTI and wound infection was utilized. Multivariate logistic regression was performed to identify risk factors. RESULTS: The mean age of participants in both cohorts was 49.7 years old, mean BMI was 30.8, and the average stricture length was 4.09 cm. Overall, the rate of postoperative UTI and wound infection within 30 days was 5.1% (6.7% in phase 1 vs 3.9% in phase 2 (p=0.064), and 3.9%, (4.1% vs 3.7% p=0.772) respectively. After comparing several patient factors including comorbidities, location of stricture, and graft use, only preoperative UTI was a significant predictor of postoperative UTI (p=0.043). No characteristic was significant for wound infections. CONCLUSIONS: The usage of prolonged postoperative antibiotics did not decrease postoperative UTI or wound infection rates. A standardized protocol minimized antibiotic use in the pre, peri and post-operative setting. Given the worldwide crisis of antibiotic overuse, standardized protocols can minimize antibiotic use in urethral reconstruction and post-operative suppressive antibiotics can be eliminated. Source of Funding: none