Antibiotic Prophylaxis

• See AUA Guidelines and CUA Guideline Notes
• Surgical wound classification:
  • Clean: uninfected wound without inflammation or entry into the genital, urinary, or alimentary tract
  • Clean-contaminated: uninfected wound with controlled entry into the genital, urinary, or alimentary tract
  • Contaminated: uninfected wound with major break in sterile technique (gross spillage from gastrointestinal tract or non-purulent inflammation)
  • Dirty: wound with preexisting clinical infection or perforated viscera
• Host factors that increase the risk of post-operative infection (10)
  1. Advanced age
  2. Anatomic anomalies
  3. Poor nutritional status
  4. Smoking
  5. Chronic corticosteroid use
  6. Immunodeficiency
  7. Chronic indwelling hardware
  8. Infected endogenous/exogenous material
  9. Distant co-existent infection
  10. Prolonged hospitalization
• Special considerations
  • Patients at risk of endocarditis
    • The risk of infectious endocarditis (IE) after urologic procedures is low.
      • Enterococcus faecaelis is the pathogen most likely responsible for IE following a genitorurinary tract bacteremia
    • The current recommendation is that the use of prophylactic antibiotics solely to prevent IE is not recommended
      • Previous guidelines from the American Heart Association had recommended routine prophylaxis
    • The guidelines do state that for patients with certain concomitant conditions (prosthetic cardiac valve, previous IE, congenital heart disease, cardiac transplantation) AND an active infection or colonization who are to undergo GU tract manipulation, including elective cystoscopy, antibiotic therapy to sterilize the urine may be reasonable (Class IIb evidence).
      • Amoxicillin or ampicillin is suggested as a first-line agent for enterococci, vancomycin for penicillin allergy
  • Patients with indwelling orthopedic hardware
    • In general, antibiotic prophylaxis for urologic patients with total joint replacements, pins, plates, or screws is not indicated.
    • Prophylaxis is advised for individuals at higher risk of seeding a prosthetic joint, including those with recently inserted implants (within 2 years) and/or host risk factors as delineated earlier

References

• Wein AJ, Kavoussi LR, Partin AW, Peters CA (eds): CAMPBELL-WALSH UROLOGY, ed 11. Philadelphia, Elsevier, 2015, vol 2, chap 12