There are no established guidelines regarding management of antibiotics for patients specifically undergoing urethral reconstruction. Our aim was to minimize antibiotic use by following a standardized protocol in the pre, peri and postoperative setting and adhere to AUA antibiotic guidelines. We hypothesized that prolonged suppressive antibiotics post-urethroplasty does not prevent urinary tract infection (UTI) and/or wound infection rates.
We prospectively treated 900 patients undergoing urethroplasty or perineal urethrostomy at 11 centers over 2 years. The first-year cohort A received prolonged postoperative antibiotics. Year two, cohort B, did not receive prolonged antibiotics. A standardized protocol following the AUA guidelines for perioperative antibiotics was used. 30-day postoperative infectious complications were determined. We used chi-square analysis to compare the cohorts, and multivariate logistic regression to identify risk factors.
The mean age of participants in both cohorts was 49.7 years old and the average stricture length was 4.09 cm. Overall, the rate of postoperative UTI and wound infection within 30 days was 5.1% (6.7% in phase 1 vs 3.9% in phase 2, p=0.064), and 3.9%, (4.1% in phase 1 vs 3.7% in phase 2, p=0.772) respectively. Multivariate logistic regression analysis of patient characteristics and operative factors did not reveal any factors predictive of postoperative infections.
The use of a standardized protocol minimized antibiotic use and demonstrated no benefit to prolonged antibiotic use. There were no identifiable risk factors when considering surgical characteristics. Given the concern of antibiotic over-prescription, we do not recommend prolonged antibiotic use after urethral reconstruction.
The Journal of urology. 2022 Feb 25 [Epub ahead of print]
Sunchin Kim, Katherine C Cheng, Nejd F Alsikafi, Benjamin N Breyer, Joshua A Broghammer, Sean P Elliott, Bradley A Erickson, Jeremy B Myers, Thomas G Smith, Alex J Vanni, Bryan B Voelzke, Lee C Zhao, Jill C Buckley
University of California San Diego, San Diego, California., University of Arizona, Tucson, Arizona., Uropartners, Gurnee, Illinois., University of California San Francisco, San Francisco, California., University of Kansas Medical Center, Kansas City, Kansas., University of Minnesota, Minneapolis, Minnesota., University of Iowa Hospitals and Clinic, Iowa City, Iowa., University of Utah, Salt Lake City, Utah., Baylor College of Medicine, Houston, Texas., Lahey Hospital and Medical Center, Burlington, Massachusetts., Spokane Urology, Spokane, Washington., New York University, New York, New York.