American Urological Association Antibiotic Best Practice Statement and Ureteroscopy - Does Antibiotic Stewardship Help?

Purpose: To determine compliance with the American Urological Association (AUA) antimicrobial prophylaxis best practice statement and whether the use of postoperative antibiotics is associated with lower rates of postoperative urinary tract infection (UTI) in patients with nephroureterolithiasis and a negative preoperative urine culture undergoing ureteroscopy. Materials and Methods: A retrospective review of all adult patients undergoing ureteroscopy from 2013 to 2014 for stone disease with a negative preoperative urine was conducted. Patients who did and did not receive postoperative oral antibiotics beyond 24 hours of surgery were identified. The rates of culture-proven postoperative UTI and unplanned postoperative encounters were determined for both groups. Between-group comparisons were made by using independent t-test and Chi-square analyses. Results: A total of 1068 patients met inclusion criteria and 31.6% were managed in accordance with the AUA best practice statement by not receiving antibiotics beyond 24 hours of surgery. Overall, 33 patients developed a culture-proven UTI within 30 days after surgery, with no difference in UTI rate between patients who did and did not receive home-going antibiotics (2.9% vs 3.6%, respectively; p=0.5). Rates of unplanned hospital encounters also did not differ between groups (23.7% vs 27.0%, respectively; p=0.2). On multivariate regression, culture-proven UTI within 1 year before surgery was the only factor associated with postoperative UTI (odds ratio: 10.8, p<0.0001). Conclusions: Patients who did and did not receive home-going antibiotics after ureteroscopy demonstrated similar rates of postoperative UTI and unplanned hospital encounters. These results suggest that there is no benefit to extended antibiotics after ureteroscopy. The minority of patients managed in accordance with the AUA best practice statement highlights room for quality improvement.