CUA: Antibiotic Prophylaxis (2015)

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See Original Guideline

  • Risk factors for post-procedure infection:
    1. Extremes of age
    2. Immunosuppressed
    3. Nutritional status
    4. Obesity
    5. Diabetes mellitus
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