CUA: Antibiotic Prophylaxis (2015)

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