STORZ MEDICAL – Literature Databases
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Marino F. et al., 2024: Antibiotic prophylaxis in urologic interventions: Who, when, where?

Marino F, Rossi F, Murri R, Sacco E.
Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Università Cattolica Del Sacro Cuore, Rome, Italy.
Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Department of Urology, Ospedale Isola Tiberina - Gemelli Isola, Rome, Italy.
Department of Infectious Disease, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.

Abstract

Background: Periprocedural prophylaxis in medicine encompasses the set of measures (physical, chemical, and pharmacological) used to reduce the risk of infection. Antibiotic prophylaxis (AP) refers to the administration of a short-term regimen of antibiotics shortly before a medical procedure to reduce the risk of infectious complications that can result from diagnostic and therapeutic interventions. The outspreading growth of multidrug-resistant bacterial species and changes in the bacterial local ecosystem have impeded the development of a unique scheme of AP in urology.

Objectives: To review the literature and current guidelines regarding AP for urological diagnostic and therapeutic procedures, and to define agents, timing, and occasions when administering pharmacological prophylaxis. Secondly, according to current literature, to open new scenarios where AP can be useful or useless.

Results: Major gaps in evidence still exist in this field. AP appears useful in many invasive procedures and some sub-populations at risk of infectious complications. AP is not routinely recommended for urodynamic exams, diagnostic cystoscopy, and extracorporeal shock-wave lithotripsy. The available data regarding the use of AP during the transperineal prostate biopsy are still unclear; conversely, in the case of the transrectal approach AP is mandatory. AP is still considered the gold standard for the prevention of postoperative infective complications in the case of ureteroscopy, percutaneous nephrolithotomy, endoscopic resection of bladder tumor, endoscopic resection of the prostate, and prosthetic or major surgery.

Conclusion: The review highlights the complexity of determining the appropriate candidates for AP, emphasizing the importance of considering patient-specific factors such as comorbidities, immunocompetence, and the nature of the urologic intervention. The evidence suggests that a one-size-fits-all approach may not be suitable, and a tailored strategy based on the specific procedure and patient characteristics is essential.

Urologia. 2024 Jan 30:3915603231226265. doi: 10.1177/03915603231226265. Online ahead of print. PMID: 38288737

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Comments 1

Peter Alken on Monday, 17 June 2024 11:00

This is the summary of the short paragraph on AP and ESWL. “In conclusion, no study showed a benefit in performing AP in patients undergoing ESWL. No AP is needed before or during this procedure according to EAU guidelines. According to the AUA guidelines, ESWL does not require AP if the pre-procedure urine culture is negative.”
See also: Predictive markers for infections after extracorporeal shockwave lithotripsy in patients with kidney stone based on a large prospective cohort.
Liu B, Pan S, Wang L, Bai S, Liu D.
World J Urol. 2024 Jan 30;42(1):63. doi: 10.1007/s00345-024-04769-w.
PMID: 38289424

Peter Alken

This is the summary of the short paragraph on AP and ESWL. “In conclusion, no study showed a benefit in performing AP in patients undergoing ESWL. No AP is needed before or during this procedure according to EAU guidelines. According to the AUA guidelines, ESWL does not require AP if the pre-procedure urine culture is negative.” See also: Predictive markers for infections after extracorporeal shockwave lithotripsy in patients with kidney stone based on a large prospective cohort. Liu B, Pan S, Wang L, Bai S, Liu D. World J Urol. 2024 Jan 30;42(1):63. doi: 10.1007/s00345-024-04769-w. PMID: 38289424 Peter Alken
Friday, 12 July 2024