The following is a summary of “Post-procedural Antibiotic Use and Associated Outcomes After Common Urologic Procedures Across a National Healthcare System,” published in the JANUARY 2023 issue of Urology by Granado, et al.
For a study, researchers sought to evaluate the advantages and disadvantages of administering antibiotics after standard urologic procedures.
The study included patients who underwent a urologic endoscopic procedure in the Veterans Health Administration between January 1, 2017, and June 30, 2021. Post-procedural antibiotics were defined as antibiotics prescribed on the day following the procedure. Guidelines usually did not recommend post-procedural antibiotics for surgical prophylaxis. The study measured the association between post-procedural antibiotic use and two outcomes: unplanned return visits and Clostridioides difficile infection within 30 days. The data was analyzed using log-binomial models with risk adjustment, and hospital-level observed-to-expected (O:E) ratios were used to compare post-procedural antibiotic use.
The results of the study showed that 27,422 (36.7%) of the 105 institutions’ 74,629 qualified procedures received post-procedural antibiotics (median 3 days, IQR 3-6). In comparison to patients who did not receive post-procedural antibiotics 17.2%, 20.2% of those patients experienced an unanticipated return visit (adjusted RR 1.032, 95% CI 0.999-1.066). In those who got post-procedural antibiotics vs. those who did not (adjusted RR 1.67, 95% CI 1.13-2.45), C. difficile infection was identified in 0.27% vs. 0.10% of patients. For institutions in the lowest and highest use quartile, the O:E ratio for post-procedural antibiotic usage varied from 0.46 to 1.93.
In conclusion, post-procedural antibiotics were frequently prescribed after urologic procedures, with large inter-facility variability even after adjusting for case-mix differences. Although post-procedural antibiotics were associated with an increased risk of C. difficile infection, it did not reduce the risk of unplanned return visits. Therefore, efforts were needed to reduce the guideline-discordant use of post-procedural antibiotics.
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