Skip to main content

Advertisement

SpringerLink
Log in

Current Bladder Dysfunction Reports: Antibiotic Overuse in Office-Based Lower Urinary Tract Procedures

  • Outcomes in Functional Urology (A Cameron, Section Editor)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this review is to describe antibiotic overuse in office-based urologic interventions. The evidence for antibiotic prophylaxis for common office-based urologic procedures and testing will be summarized.

Recent Findings

Multiple studies have demonstrated the impact of antibiotic overuse on the emergence of antibiotic resistance. Within the field of urology, improper procedural antibiotic prophylaxis may represent a source of antibiotic overuse. Despite published guidelines, there remains a lack of procedure and patient-specific data on best prophylaxis practices, particularly as it relates to office-based testing and interventions. Non-antimicrobial prophylaxis has not been well studied in the outpatient setting.

Summary

High-level research is required to identify optimal antibiotic prophylaxis regimens and duration for specific outpatient urologic procedures. Further study on the appropriate stratification of patients may allow for a more individualized approach to prophylaxis in the non-index patient. Non-antimicrobial alternatives may be an option for prophylaxis; however, further study is required.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Lightner DJ, Wymer K, Sanchez J, Kavoussi L. Best practice statement on urologic procedures and antimicrobial prophylaxis. J Urol. 2020;203(2):351–6. American Urology Association Guideline for Antimicrobial Prophylaxis.

    Article  Google Scholar 

  2. Khaw C, Oberle AD, Lund BC, Egge J, Heintz BH, Erickson BA, et al. Assessment of guideline discordance with antimicrobial prophylaxis best practices for common urologic procedures. JAMA Netw Open. 2018;1(8):e186248.

    Article  Google Scholar 

  3. Mossanen M, Calvert JK, Holt SK, James AC, Wright JL, Harper JD, et al. Overuse of antimicrobial prophylaxis in community practice urology. J Urol. 2015;193(2):543–7.

    Article  Google Scholar 

  4. Shallcross LJ, Davies DSC. Antibiotic overuse: a key driver of antimicrobial resistance. Br J Gen Pract. 2014;64(629):604–5.

    Article  Google Scholar 

  5. Aminov RI. A brief history of the antibiotic era: lessons learned and challenges for the future. Front Microbiol. 2010;8(1):134.

    Google Scholar 

  6. Plackett B. Why big pharma has abandoned antibiotics. Nature. 2021;586(7830):50–2. Explanation for lack of recent antibiotic development.

    Article  Google Scholar 

  7. Davies J, Davies D. Origins and evolution of antibiotic resistance. Microbiol Mol Biol Rev. 2010;74(3):417–33.

    Article  CAS  Google Scholar 

  8. Guidos RJ. Combating antimicrobial resistance: policy recommendations to save lives. Clin Infect Dis. 2011;52(Suppl 5):S397-428.

    Google Scholar 

  9. Dadgostar P. Antimicrobial resistance: implications and costs. Infect Drug Resist. 2019;20(12):3903–10.

    Article  Google Scholar 

  10. Blaser MJ, Melby MK, Lock M, Nichter M. Accounting for variation in and overuse of antibiotics among humans. BioEssays. 2021;43(2):2000163.

    Article  Google Scholar 

  11. Klein T, Winkler A, Vahdad RM, Ekamp A, Boemers TM. The Cologne pouch procedure for continent anal urinary diversion in children with bladder exstrophy–epispadias complex. J Pediatr Urol. 2018;14(5):431.e431-431.e436.

    Article  Google Scholar 

  12. Sulis G, Daniels B, Kwan A, Gandra S, Daftary A, Das J, et al. Antibiotic overuse in the primary health care setting: a secondary data analysis of standardised patient studies from India, China and Kenya. BMJ Glob Health. 2020;5(9):e003393.

    Article  Google Scholar 

  13. Sulis G, Adam P, Nafade V, Gore G, Daniels B, Daftary A, et al. Antibiotic prescription practices in primary care in low- and middle-income countries: a systematic review and meta-analysis. PLoS Med. 2020;17(6):e1003139. Systematic review demonstrating evolving overuse of antimicrobials in low- and middle-income countries.

    Article  Google Scholar 

  14. Stover KR, Chahine EB, Cluck D, Green S, Chastain DB, Childress D, et al. A baker’s dozen of top antimicrobial stewardship intervention publications in 2019. Open Forum Infect Dis. 2020;7(10):ofaa402.

    Article  Google Scholar 

  15. Reardon S. WHO warns against “post-antibiotic” era. Nature. 2014. https://doi.org/10.1038/nature.2014.15135.

  16. Anger J, Lee U, Ackerman AL, Chou R, Chughtai B, Clemens JQ, et al. Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU guideline. J Urol. 2019;202(2):282–9.

    Article  Google Scholar 

  17. Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103-120.

    Article  Google Scholar 

  18. Llor C, Rabanaque G, López A, Cots JM. The adherence of GPs to guidelines for the diagnosis and treatment of lower urinary tract infections in women is poor. Fam Pract. 2011;28(3):294–9.

    Article  Google Scholar 

  19. Barlam TF, Cosgrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016;62(10):e51-77.

    Article  Google Scholar 

  20. Hicks LA, Bartoces MG, Roberts RM, Suda KJ, Hunkler RJ, Taylor TH Jr, et al. US outpatient antibiotic prescribing variation according to geography, patient population, and provider specialty in 2011. Clin Infect Dis. 2015;60(9):1308–16.

    Google Scholar 

  21. Durkin MJ, Hsueh K, Sallah YH, Feng Q, Jafarzadeh SR, Munshi KD, et al. An evaluation of dental antibiotic prescribing practices in the United States. J Am Dent Assoc. 2017;148(12):878-886.e1.

    Article  Google Scholar 

  22. Ross JPJ, Breau RH, Vigil H, Hickling DR, Angel JB, Mallick R, et al. Association between radical cystectomy prophylactic antimicrobial regimen and postoperative infection. Can Urol Assoc J. 2021;15(12):E644–51.

    Article  Google Scholar 

  23. Grabe M. Controversies in antibiotic prophylaxis in urology. Int J Antimicrob Agents. 2004;1(23):17–23.

    Article  Google Scholar 

  24. Almallah YZ, Rennie CD, Stone J, Lancashire MJ. Urinary tract infection and patient satisfaction after flexible cystoscopy and urodynamic evaluation. Urology. 2000;56(1):37–9.

    Article  CAS  Google Scholar 

  25. Olson ES, Cookson BD. Do antimicrobials have a role in preventing septicaemia following instrumentation of the urinary tract? J Hosp Infect. 2000;45(2):85–97.

    Article  CAS  Google Scholar 

  26. Burke DM, Shackley DC, O’Reilly PH. The community-based morbidity of flexible cystoscopy. BJU Int. 2002;89(4):347–9.

    Article  CAS  Google Scholar 

  27. Zeng S, Zhang Z, Bai Y, Sun Y, Xu C. Antimicrobial agents for preventing urinary tract infections in adults undergoing cystoscopy. Cochrane Database Syst Rev. 2019;2019(2):12305. Cochrane systematic review on the benefit of antimicrobial prophylaxis for patients undergoing cystoscopy.

    Google Scholar 

  28. Carey MM, Zreik A, Fenn NJ, Chlosta PL, Aboumarzouk OM. Should we use antibiotic prophylaxis for flexible cystoscopy? a systematic review and meta-analysis. UIN. 2015;95(3):249–59.

    Google Scholar 

  29. Pickard R, Bartoletti R, Bjerklund-Johansen TE, Bonkat G, Bruyère F, Çek M, et al. EAU guidelines on urological infections. Arnhem: EAU Guidelines Office; 2022. European Urology Association guidelines for treatment of urologic infection.

  30. Bradshaw AW, Pe M, Bechis SK, Dipina T, Zupkas P, Abbott JE, et al. Antibiotics are not necessary during routine cystoscopic stent removal: a randomized controlled trial at UC San Diego. Urol Ann. 2020;12(4):373–8. Randomized controlled trial on the efficacy of antimicrobial prophylaxis in patients undergoing cystoscopy and ureteric stent removal.

    Article  CAS  Google Scholar 

  31. Abbott JE, Han A, McDonald M, Lakin C, Sur RL. Are antibiotics necessary during routine cystoscopic stent removal? Transl Androl Urol. 2016;5(5):784–8.

    Article  Google Scholar 

  32. Olivero A, Riccardi N, Ndrevataj D, Balzarini F, Cerasuolo M, Bottino P, et al. Flexible cystoscopy for ureteral stent removal without antimicrobial prophylaxis a prospective observational study. Urologia. 2021;88(2):130–4.

    Article  Google Scholar 

  33. Okorocha I, Cumming G, Gould I. Female urodynamics and lower urinary tract infection. BJU Int. 2002;89(9):863–7.

    Article  CAS  Google Scholar 

  34. Onur R, Özden M, Orhan I, Kalkan A, Semercioz A. Incidence of bacteraemia after urodynamic study. J Hosp Infect. 2004;57(3):241–4.

    Article  CAS  Google Scholar 

  35. Foon R, Toozs‐Hobson P, Latthe P. Prophylactic antibiotics to reduce the risk of urinary tract infections after urodynamic studies. Cochrane Database Syst Rev. 2012;81(10). Available from: https://doi.org/10.1002/14651858.CD008224.pub2/full. Cochrane systematic review on routine antibiotic prophylaxis for urodynamic studies.

  36. Benseler A, Anglim B, Zhao ZY, Walsh C, McDermott CD. Antibiotic prophylaxis for urodynamic testing in women: a systematic review. Int Urogynecol J. 2021;32(1):27–38.

    Article  Google Scholar 

  37. Böthig R, Fiebag K, Thietje R, Faschingbauer M, Hirschfeld S. Morbidity of urinary tract infection after urodynamic examination of hospitalized SCI patients: the impact of bladder management. Spinal Cord. 2013;51(1):70–3.

    Article  Google Scholar 

  38. Darouiche RO, Smith MS, Markowski J. Antibiotic prophylaxis for urodynamic testing in patients with spinal cord injury: a preliminary study. J Hosp Infect. 1994;28(1):57–61.

    Article  CAS  Google Scholar 

  39. Pannek J, Nehiba M. Morbidity of urodynamic testing in patients with spinal cord injury: is antibiotic prophylaxis necessary? Spinal Cord. 2007;45(12):771–4.

    Article  CAS  Google Scholar 

  40. Liu N, Chen M, Chen SQ, Xu B, Mao XY. Preventive administration of antibiotics to patients with benign prostatic hyperplasia before urodynamic examination. Zhonghua Nan Ke Xue. 2013;19(11):996–8.

    Google Scholar 

  41. Simsir A, Mammadov R, Kizilay F, Ozyurt M. The need for antibiotic prophylaxis before urodynamic studies. Turk J Med Sci. 2011;41(5):883–7.

    Google Scholar 

  42. Bombieri L, Dance DA, Rienhardt GW, Waterfield A, Freeman RM. Urinary tract infection after urodynamic studies in women: incidence and natural history. BJU Int. 1999;83(4):392–5.

    Article  CAS  Google Scholar 

  43. Brocklehurst JC, Dillane JB, Griffiths L, Fry J. The prevalence and symptomatology of urinary infection in an aged population. Gerontol Clin (Basel). 1968;10(4):242–53.

    Article  CAS  Google Scholar 

  44. Cameron AP, Campeau L, Brucker BM, Clemens JQ, Bales GT, Albo ME, et al. Best practice policy statement on urodynamic antibiotic prophylaxis in the non-index patient. Neurourol Urodyn. 2017;36(4):915–26. Best practice statement for the use of antibiotic prophylaxis in the non-index patient undergoing urodynamics.

    Article  CAS  Google Scholar 

  45. Saint S, Lipsky BA. Preventing catheter-related bacteriuria: should we? Can we? How? Arch Intern Med. 1999;159(8):800–8.

    Article  CAS  Google Scholar 

  46. Warren JW, Damron D, Tenney JH, Hoopes JM, Deforge B, Muncie HL. Fever, bacteremia, and death as complications of bacteriuria in women with long-term urethral catheters. J Infect Dis. 1987;155(6):1151–8.

    Article  CAS  Google Scholar 

  47. Liu L, Jian Z, Li H, Wang K. Antibiotic prophylaxis after extraction of urinary catheter prevents urinary tract infections: A systematic review and meta-analysis. Am J Infect Control. 2021;49(2):247–54. Systematic review on antibiotic prophylaxis for urinary catheter removal.

    Article  CAS  Google Scholar 

  48. Marschall J, Carpenter CR, Fowler S, Trautner BW. Antibiotic prophylaxis for urinary tract infections after removal of urinary catheter: meta-analysis. BMJ. 2013;11(346):f3147.

    Article  Google Scholar 

  49. Kolwijck E, Seegers AEM, Tops SCM, van der Heijden AG, Sedelaar JPM, ten Oever J. Incidence and microbiology of post-operative infections after radical cystectomy and ureteral stent removal; a retrospective cohort study. BMC Infect Dis [Internet]. 2019 [cited 2020 Jun 28];19. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles

  50. Hashimoto J, Takahashi S, Kurimura Y, Takeyama K, Kunishima Y, Tsukamoto T. Clinical relevance of single administration of prophylactic antimicrobial agents against febrile events after removal of ureteral stents for patients with urinary diversion or reconstruction. Int J Urol. 2010;17(2):163–6.

    Article  CAS  Google Scholar 

  51. Brubaker L, Richter HE, Visco A, Mahajan S, Nygaard I, Braun TM, et al. Refractory idiopathic urge urinary incontinence and botulinum A injection. J Urol. 2008;180(1):217–22.

    Article  Google Scholar 

  52. Khan MH, Baldo O, Koenig P, Shaikh N. Use of prophylactic antibiotics for intra-vesicle Botox® injection. Neurourol Urodyn. 2017;36(3):828–828.

    Article  Google Scholar 

  53. Houman J, Moradzadeh A, Patel DN, Asanad K, Anger JT, Eilber KS. What is the ideal antibiotic prophylaxis for intravesically administered Botox injection? A comparison of two different regimens. Int Urogynecol J. 2019;30(5):701–4.

    Article  Google Scholar 

  54. Eckhardt SE, Takashima Y, Handler SJ, Tenggardjaja C, Yazdany T. Antibiotic regimen and route of administration do not alter rates of urinary tract infection after intravesical botulinum toxin injection for overactive bladder. Int Urogynecol J. 2021;33(3):703–9. Retrospective cohort study on antibiotic prophylaxis in patients undergoing intravesical botulinum toxin injections.

  55. Forbes R, Ali A, Abouhajar A, Brennand C, Brown H, Carnell S, et al. Alternatives to prophylactic antibiotics for the treatment of recurrent urinary tract infection in women (ALTAR): study protocol for a multicentre, pragmatic, patient-randomised, non-inferiority trial. Trials. 2018;19(1):616.

    Article  Google Scholar 

  56. Kranjčec B, Papeš D, Altarac S. D-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial. World J Urol. 2014;32(1):79–84.

    Article  Google Scholar 

  57. Perrotta C, Aznar M, Mejia R, Albert X, Ng CW. Oestrogens for preventing recurrent urinary tract infection in postmenopausal women. Obstet Gynecol. 2008;112(3):689–90.

    Article  CAS  Google Scholar 

  58. Hooton TM, Vecchio M, Iroz A, Tack I, Dornic Q, Seksek I, et al. Effect of increased daily water intake in premenopausal women with recurrent urinary tract infections. JAMA Intern Med. 2018;178(11):1509–15.

    Article  Google Scholar 

  59. Foxman B, MsAEW Cronenwett, Spino C, Berger MB, Morgan DM. Cranberry juice capsules and urinary tract infection post surgery: results of a randomized trial. Am J Obstet Gynecol. 2015;213(2):194.e1-194.e8.

    Article  Google Scholar 

  60. Mooren ES, Liefers WJ, de Leeuw JW. Cranberries after pelvic floor surgery for urinary tract infection prophylaxis: a randomized controlled trial. Neurourol Urodyn. 2020;39(5):1543–9.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Functional and Reconstructive Urology, Department of Surgery, Division of Urology, University of Ottawa, 1053 Carling Ave, Ottawa, ON, K1Y4E9, Canada

    James Ross

  2. Female Pelvic Medicine and Reconstructive Surgery, Department of Surgery, Division of Urology, University of Ottawa, 1053 Carling Ave, Ottawa, ON, K1Y4E9, Canada

    Duane Hickling

Authors
  1. James Ross
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Duane Hickling
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Duane Hickling.

Ethics declarations

Conflict of Interest

James Ross has been an advisory board member for AbbVie.

Duane Hickling has been an advisory board member for Pfizer; a speakers’ bureau member for Allergan, Astellas, and Pfizer; has received grants/honoraria from Allergan, Astellas, and Pfizer; and has participated in clinical trials supported by Astellas.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Outcomes in Functional Urology

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ross, J., Hickling, D. Current Bladder Dysfunction Reports: Antibiotic Overuse in Office-Based Lower Urinary Tract Procedures. Curr Bladder Dysfunct Rep 17, 279–286 (2022). https://doi.org/10.1007/s11884-022-00672-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11884-022-00672-5

Keywords

Search

Navigation