uti Urogenital Tract Infection Urogenit Tract Infect 2465-8243 2465-8510 Korean Association of Urogenital Tract Infection and Inflammation 10.14777/uti.2019.14.1.1 uti-14-1 Review Recommendations for Antibacterial Prophylaxis in Endourological Procedures ChungDoo Yong LeeJoo Yong 1 Department of Urology, Inha University School of Medicine, Incheon, Korea Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea Correspondence to: Joo Yong Lee https://orcid.org/0000-0002-3470-1767 Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: +82-2-2228-2320, Fax: +82-2-312-2538 E-mail: joouro@yuhs.ac 042019 20042019 141 18 11022019 17042019 18042019 Copyright © 2019 Korean Association of Urogenital Tract Infection and Inflammation 2019 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract

This review discusses the evidence and newly identified findings of antibiotic prophylaxis in endourological procedures based on recently published studies. Endoscopic procedures and surgeries are performed widely to treat a variety of urologic diseases. The panel of European Association of Urology (EAU) guidelines on UTIs decided not to make recommendations for specific agents for particular procedures because there are considerable variations in Europe and worldwide regarding bacterial pathogens, their susceptibility, and the availability of antibiotic agents in 2018. In the EAU guidelines, antimicrobial prophylactic therapies cannot decrease the rate of symptomatic UTI in several procedures, including cystoscopy and extracorporeal shock wave lithotripsy. Perioperative antibiotic prophylaxis can be helpful in all patients undergoing endourological treatment, including ureteroscopic surgery and percutaneous nephrolithotomy. Because the urological practice is a part of the surgery, most urological treatment can be performed mainly by surgery. The prevention of surgical infections in each surgical field is a critical issue, but the evidence and number of guidelines are limited.

 Urinary tract infections Urology Endoscopy Urinary calculi Cystoscopy References Cornu JN Herrmann T Traxer O Matlaga B Prevention and management following complications from endourology procedures Eur Urol Focus 20162 4959 Herrmann TR Liatsikos EN Nagele U Traxer O Merseburger AS EAU Guidelines Panel on Lasers, Technologies EAU guidelines on laser technologies Eur Urol 201261 78395 Oelke M Bachmann A Descazeaud A Emberton M Gravas S Michel MC European Association of Urology EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction Eur Urol 201364 11840 Turk C Petrik A Sarica K Seitz C Skolarikos A Straub M EAU guidelines on interventional treatment for urolithiasis Eur Urol 201669 47582 Babjuk M Bohle A Burger M Capoun O Cohen D Comperat EM EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2016 Eur Urol 201771 44761 Dasgupta R Grabe M Preoperative antibiotics before endo-urologic surgery: current recommendations J Endourol 200923 156770 Jung HD Kim JC Ahn HK Kwon JH Han K Han WK Realtime simultaneous endoscopic combined intrarenal surgery with intermediate-supine position: washout mechanism and transport technique Investig Clin Urol 201859 34854 Knopf HJ Graff HJ Schulze H Perioperative antibiotic prophylaxis in ureteroscopic stone removal Eur Urol 200344 1158 Draga RO Kok ET Sorel MR Bosch RJ Lock TM Percutaneous nephrolithotomy: factors associated with fever after the first postoperative day and systemic inflammatory response syndrome J Endourol 200923 9217 Eswara JR Shariftabrizi A Sacco D Positive stone culture is associated with a higher rate of sepsis after endourological procedures Urolithiasis 201341 4114 Lawson KA Rudzinski JK Vicas I Carlson KV Assessment of antibiotic prophylaxis prescribing patterns for TURP: a need for Canadian guidelines? Can Urol Assoc J 20137 E5306 Tanner J Dumville JC Norman G Fortnam M Surgical hand antisepsis to reduce surgical site infection Cochrane Database Syst Rev 20161 CD004288 Assimos D Krambeck A Miller NL Monga M Murad MH Nelson CP Surgical management of stones: American Urological Association/Endourological Society guideline, part I J Urol 2016196 115360 Assimos D Krambeck A Miller NL Monga M Murad MH Nelson CP Surgical management of stones: American Urological Association/Endourological Society guideline, part II J Urol 2016196 11619 Gupta K Hooton TM Naber KG Wullt B Colgan R Miller LG International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases Clin Infect Dis 201152 e10320 Hooton TM Bradley SF Cardenas DD Colgan R Geerlings SE Rice JC Infectious Diseases Society of America Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 international clinical practice guidelines from the Infectious Diseases Society of America Clin Infect Dis 201050 62563 Matsumoto T Kiyota H Matsukawa M Yasuda M Arakawa S Monden K Japanese Society of UTI Cooperative Study Group (Chairman; Tetsuro Matsumoto) Japanese guidelines for prevention of perioperative infections in urological field Int J Urol 200714 890909 Carey MM Zreik A Fenn NJ Chlosta PL Aboumarzouk OM Should we use antibiotic prophylaxis for flexible cystoscopy? A systematic review and metaanalysis Urol Int 201595 24959 Garcia-Perdomo HA Jimenez-Mejias E Lopez-Ramos H Efficacy of antibiotic prophylaxis in cystoscopy to prevent urinary tract infection: a systematic review and metaanalysis Int Braz J Urol 201541 41224; discussion 424. Cam K Kayikci A Erol A Prospective evaluation of the efficacy of antibiotic prophylaxis before cystoscopy Indian J Urol 200925 2036 Garcia-Perdomo HA Lopez H Carbonell J Castillo D Catano JG Seron P Efficacy of antibiotic prophylaxis in patients undergoing cystoscopy: a randomized clinical trial World J Urol 201331 14339 Rane A Cahill D Saleemi A Montgomery B Palfrey E The issue of prophylactic antibiotics prior to flexible cystoscopy Eur Urol 200139 2124 Mrkobrada M Ying I Mokrycke S Dresser G Elsayed S Bathini V CUA guidelines on antibiotic prophylaxis for urologic procedures Can Urol Assoc J 20159 1322 Berry A Barratt A Prophylactic antibiotic use in transurethral prostatic resection: a metaanalysis J Urol 2002167 5717 Qiang W Jianchen W MacDonald R Monga M Wilt TJ Antibiotic prophylaxis for transurethral prostatic resection in men with preoperative urine containing less than 100,000 bacteria per ml: a systematic review J Urol 2005173 117581 Yokoyama M Fujii Y Yoshida S Saito K Koga F Masuda H Discarding antimicrobial prophylaxis for transurethral resection of bladder tumor: a feasibility study Int J Urol 200916 613 Janknegt RA Prophylaxis in urological surgery Infection. 199220 Suppl 3 S2136; discussion S217–20, S224. Westenfelder M Rosset K Pelz K Development of nosocomial and iatrogenic urinary tract infections (UTI) following urolo-gical interventions. A prospective clinical study Scand J Urol Nephrol Suppl 1987104 5963 Bootsma AM Laguna Pes MP Geerlings SE Goossens A Antibiotic prophylaxis in urologic procedures: a systematic review Eur Urol 200854 127086 Delavierre D Huiban B Fournier G Le Gall G Tande D Mangin P [The value of antibiotic prophylaxis in transurethral resection of bladder tumors. Apropos of 61 cases] Prog Urol 19933 57782 French. MacDermott JP Ewing RE Somerville JF Gray BK Cephradine prophylaxis in transurethral procedures for carcinoma of the bladder Br J Urol 198862 1369 Appell RA Flynn JT Paris AM Blandy JP Occult bacterial colonization of bladder tumors J Urol 1980124 3456 Chung DY Cho KS Lee DH Han JH Kang DH Jung HD Impact of colic pain as a significant factor for predicting the stone free rate of one-session shock wave lithotripsy for treating ureter stones: a Bayesian logistic regression model analysis PLoS One 201510 e0123800 Lu Y Tianyong F Ping H Liangren L Haichao Y Qiang W Antibiotic prophylaxis for shock wave lithotripsy in patients with sterile urine before treatment may be unnecessary: a systematic review and metaanalysis J Urol 2012188 4418 Hsieh CH Yang SS Chang SJ The effectiveness of prophylactic antibiotics with oral levofloxacin against post-shock wave lithotripsy infectious complications: a randomized controlled trial Surg Infect (Larchmt) 201617 34651 Fujita K Mizuno T Ushiyama T Suzuki K Hadano S Satoh S Complicating risk factors for pyelonephritis after extracorporeal shock wave lithotripsy Int J Urol 20007 22430 Shigeta M Yamasaki A Hayashi M [A clinical study on upper urinary tract calculi treated with extracorporeal shock wave lithotripsy (ESWL) monotherapy, with regard to bacteriuria before ESWL treatment] Jpn J Urol 199384 86672 Japanese. Dincel C Ozdiler E Ozenci H Tazici N Kosar A Incidence of urinary tract infection in patients without bacteriuria undergoing SWL: comparison of stone types J Endourol 199812 13 Honey RJ Ordon M Ghiculete D Wiesenthal JD Kodama R Pace KT A prospective study examining the incidence of bacteriuria and urinary tract infection after shock wave lithotripsy with targeted antibiotic prophylaxis J Urol 2013189 21127 Fourcade RO Antibiotic prophylaxis with cefotaxime in endoscopic extraction of upper urinary tract stones: a randomized study. The cefotaxime cooperative group J Antimicrob Chemother 199026 Suppl A:77–83. Lo CW Yang SS Hsieh CH Chang SJ Effectiveness of prophylactic antibiotics against post-ureteroscopic lithotripsy infections: systematic review and metaanalysis Surg Infect (Larchmt) 201516 41520 Mariappan P Smith G Bariol SV Moussa SA Tolley DA Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy: a prospective clinical study J Urol 2005173 16104 Kang SK Cho KS Kang DH Jung HD Kwon JK Lee JY Systematic review and metaanalysis to compare success rates of retrograde intrarenal surgery versus percutaneous nephrolithotomy for renal stones ＞2 cm: an update Medicine (Baltimore) 201796 e9119 Seyrek M Binbay M Yuruk E Akman T Aslan R Yazici O Perioperative prophylaxis for percutaneous nephrolithotomy: randomized study concerning the drug and dosage J Endourol 201226 14316 Tuzel E Aktepe OC Akdogan B Prospective comparative study of two protocols of antibiotic prophylaxis in percutaneous nephrolithotomy J Endourol 201327 1726 Tables

Recommendations according to the guidelines for antibiotic prophylaxis in endourological procedures

Procedure Risk factor Guidelines
European Association of Urology American Urological Association Japanese Urological Association Canadian Urological Association
Cystoscopy Most patients Not recommended Not recommended Not recommended Not recommended
High risk patients (the presence of a urethral catheter or ureteral stent, intermittent self-catheterization, urinary retention, and recent history of UTIs, etc.) Not mentioned Not mentioned Recommended Recommended
TURPa) All patients Recommended Recommended Recommended Recommended
TURBTa) All patients Weakly recommended Recommended Recommended Not mentioned
ESWL Most patients Not recommended Not recommended Not recommended Not recommended
High risk patients (preoperative bacteriuria, repeated ESWL, infected stones, and stones with a size of ≥2 cm, etc.) Not mentioned Recommended Recommended Recommended
       
       
       
Ureteroscopy All patients Recommended Recommended Recommended Recommended
Percutaneous nephrolithotomy All patients Recommended Recommended Recommended Recommended

TURP: transurethral resection of prostate, TURBT: transurethral resection of bladder tumor, ESWL: extracorporeal shock wave lithotripsy, UTI: urinary tract infection.

Asymptomatic bacteriuria should be screened and treated before procedures with mucosal bleeding including TURP and TURBT.