Editing CUA: Antibiotic Prophylaxis (2015)

'''See [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336023/ Original Guideline]''' 

* '''Risk factors for post-procedure infection:'''
*# '''Extremes of age'''
*# '''Immunosuppressed'''
*# '''Nutritional status'''
*# '''Obesity'''
*# '''Diabetes mellitus'''

{| class="wikitable"
|'''Procedure'''
|'''Prophylaxis recommendation'''
|'''Details'''
|-
|'''Diagnosis procedures (cystoscopy, urodynamics, retrograde pyelography, etc.)'''
|'''High-risk'''
|
* Pre-procedural antibiotics show a strong trend towards reducing the risk of UTI, but not fever, after endoscopic urologic procedures
|-
|'''TRUS biopsy'''
|'''All'''
|
* '''High risk of adverse infection-related events in patients undergoing transrectal prostate biopsy.'''  
* '''Insufficient evidence for efficacy of pre-procedural enemas to recommend their routine use.'''
* In patients at increased risk of harboring resistant organisms (previous history of urosepsis, or multiple treatments with antibiotics, perirectal culture swabs prior to transrectal prostate biopsy should be considered.
|-
|'''TURP'''
|'''All'''
|
* Pre-procedural antibiotics reduce the risk of febrile UTI after TURP
|-
|'''TURBT'''
|'''High-risk'''
|
|-
|'''ESWL'''
|'''High-risk'''
|
* Pre-procedural antibiotics do not significantly reduce the risk of UTI and fever in patients undergoing ESWL but should be considered in patients at high risk of infectious complications.
* '''Patients with large stone burden, associated pyuria, history of pyelonephritis, and adjunctive operative procedure including stent, nephrostomy insertion, PCNL or ureteroscopy are at a higher risk of developing pyelonephritis post-ESWL'''.
|-
|'''Stone manipulation procedures (URS, PCNL)'''
|'''All'''
|
* Antibiotics reduce the risk of UTI following non-ESWL stone manipulation procedures, and there is a trend towards a reduction in the incidence of fever.
|}

* The choice of specific agent for prophylaxis should be based, in part, on the local epidemiology of drug resistance in potential uropathogens
* '''The American Heart Association no longer recommends urologic prophylaxis to prevent endocarditis in at-risk patients'''