A short course of antibiotic therapy for asymptomatic bacteriuria before urologic procedures
Asymptomatic bacteriuria (ASB) is
seen in some healthy female populations and many women or men
with genitourinary tract abnormalities.
Although in many clinical situations ASB is harmless, many patients with ASB are treated unnecessary. Especially, long-term antimicrobial therapy of ASB may select for superinfection with more antimicrobial-resistant microorganisms, the increased risk of drug-drug interaction and side effects, prominent collateral damage, including bacterial vaginosis, vaginal candidiasis and Clostridium difficile–associated disease, increase in cost and negatively affect the quality of life.
It is crucial to identify the special clinical settings for which screening and treatment of ASB is beneficial.
Take Home Message:
Asymptomatic bacteriuria treatment is recommended only in pregnant women or the patients before undergoing urologic surgical procedures associated with mucosal trauma by the Infectious Diseases Society of America (IDSA).
Authors reviewed the effectiveness of single or two-dose antimicrobial treatment, and post-procedure infectious complications in a large group of patients in the current study.
In the presence of ASB before the urological procedure, the duration of antimicrobial treatment is important to prevent the undesired effects of antimicrobials. Although short-course treatment may not eradicate the microorganism from the urinary system, it can prevent bacteremia and sepsis.
This study showed that a single dose or two doses of antimicrobial therapy was effective in preventing severe infectious complications such as upper UTI and septicemia following urological procedures in patients with pre-procedure ASB.
Antimicrobial prophylaxis is recommended for the transrectal prostate biopsy which is accepted as a high-risk class III/contaminated procedure.
However, ASB screening and treatment is not routinely recommended before prostate biopsy because of microorganisms causing UTI after the procedure are mostly the members of the rectal flora.
Authors found that a single dose of parenteral antimicrobial drug administered 30-60 minutes before the urologic procedures and a second dose in the presence of a post-procedure catheter, was effective to prevent post-procedure septicemia and UTI.
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Introduction: In the presence of asymptomatic bacteriuria (ASB) before the urological procedure, the duration of antimicrobial treatment is controversial. This study aims to evaluate whether a short course of antimicrobial therapy is safe and effective in cases with ASB before urological procedures.
Methodology: We retrospectively reviewed adult patients who had ASB before undergoing several urological procedures between 2011 and 2019. The patients received a single dose of an appropriate parenteral antibiotic, determined by antimicrobial sensitivity testing, 30 to 60 minutes before the urological procedure. If a urinary catheter was placed post-procedure, a second dose was given.
Results: A total of 293 patients who had ASB before undergoing several urological procedures were included in the study. The total number of procedures was 328. Female/male ratio was 92 (31.4%)/201 (68.6%).
The mean age was 63.7 ± 14.9 years. The most common isolated microorganisms were Escherichia coli (155 [47%]), Klebsiella pneumoniae (38 [11.6%]), and Pseudomonas aeruginosa (28 [8.5%]). The most common antimicrobial used was ertapenem. A second dose antimicrobial was given for 290 procedures due to a urinary catheter after a urological procedure. The mean hospitalization time was 3.97 ± 3.42 days. None of the patients developed infectious complications.
Conclusions: This study has demonstrated that a single dose of parenteral antimicrobial drug administered 30-60 minutes before the urologic procedures and a second dose in the presence of a post-procedure catheter, was adequate to prevent post-procedure septicemia and urinary tract infection.
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