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Major Shift in Antibiotic Prophylaxis Patterns Following Implementation of Guidelines-based Cystoscopy Survey

May 31, 2022

The 117th Annual Scientific Meeting of the American Urological Association (AUA) featured a presentation from UPMC Department of Urology resident Kelly R. Pekala, MD, and other collaborators, supervised by physicians Michelle Yu, MD, Benjamin J. Davies, MD, and Bruce Jacobs, MD.

Pekala discovered the implementation of a cystoscopy survey promoted rapid adoption of new AUA guidelines and further led to a significant reduction in the amount of antibiotics administered.
Inappropriate antibiotic administration has a host of well-defined deleterious downstream effects. The AUA released antibiotic guidelines for cystoscopy in June 2019 that recommended oral antibiotics only if there is a break in the mucosal barrier and fluoroquinolones were no longer the antibiotic of choice. As a result, a novel clinic-based rapid survey was created to increase AUA antibiotic guideline adherence.

To obtain baseline data, the urology clinic schedule was retrospectively reviewed for three months to identify all patients who underwent cystoscopy. A literature review was completed, and a cystoscopy survey was designed based on previous protocols and AUA guidelines to identify patients at high risk of infection. A multi-pronged intervention was implemented for a 12-month period where a ‘formal’ grand rounds presentation, ad hoc emails with individual updates, and monthly progress reports were provided. Researchers then edited the electronic health record cystoscopy order set, educated clinic staff, and started using the cystoscopy survey. They then recorded antibiotics given for prophylaxis at time of procedure, individual patient risk factors for infection, 30-day infection outcomes, and urine culture data both pre-intervention and post-intervention.

The results identified 473 cystoscopies pre-intervention, 2,137 cystoscopies in the intervention, and 417 cystoscopies post-intervention. There was a 30% decrease in the total amount of antibiotics administered and infection rates did not increase. It was found that 99% of patients were administered antibiotics pre-intervention, the majority of which were fluoroquinolones. During and after the intervention phase, fluoroquinolone use decreased significantly to 15% and 6.5%, respectively. The utilization rates of recommended antibiotics increased to 91% and persisted post-intervention.

In conclusion, implementation of a cystoscopy survey enabled rapid adoption of new AUA guidelines on antibiotic prophylaxis for cystoscopy, which resulted in a drastic reduction in the amount of antibiotics administered without a spike in infection rates. The use of recommended antibiotics improved dramatically during the intervention period and persisted post-intervention.

Read more about this study in AUA Journals.

Other study authors include:

Collaborators not affiliated with the University of Pittsburgh:

Hermoon Worku, MD
Brigham Health

Kody Armann
Colorado State University

Chandler Hudson, MD
Southern Illinois University School of Medicine