Overuse of antimicrobial prophylaxis in community practice urology

Matthew Mossanen, Joshua K. Calvert, Sarah K. Holt, Andrew C. James, Jonathan L. Wright, Jonathan D. Harper, John N. Krieger, John L. Gore

Research output: Contribution to journalArticlepeer-review

49 Scopus citations

Abstract

Purpose We examined index urological surgeries to assess utilization patterns of antimicrobial prophylaxis in a large, community based population. Materials and Methods From the Premier Perspectives Database we identified patients who underwent inpatient urological surgeries that are considered index procedures by the ABU (American Board of Urology), including radical prostatectomy, partial or radical nephrectomy, radical cystectomy, ureteroscopy, shock wave lithotripsy, transurethral resection of the prostate, percutaneous nephrostolithotomy, transvaginal surgery, inflatable penile prosthesis, brachytherapy, transurethral resection of bladder tumor and cystoscopy. Procedures were identified based on ICD-9 procedure codes for 2007 to 2012. Antimicrobial administration, class and duration were abstracted from patient billing data. The class and duration of antimicrobials concordant with the 2008 AUA Best Practice Policy Statement was used to determine compliance. Results The overall compliance rate was 53%, ranging from 0.6% for radical cystectomy to 97% for shock wave lithotripsy. Antimicrobial use consistent with AUA Best Practices included the appropriate class in 67% of cases (range 34% to 80%) and the recommended duration in 78% (range 1.2% to 98%). Average prophylaxis duration for procedures for which it is recommended ranged from 1.1 days after brachytherapy to 10.3 days after radical cystectomy. The compliance rate increased from 46% overall in 2007 to 59% overall in 2012. Conclusions We documented considerable variation in antimicrobial prophylaxis for urological surgery. Compliance with AUA Best Practices increased with time but overall rates remain less than 60%. Efforts are needed to better understand the reasons for variation from recommended antimicrobial prophylaxis for common inpatient urological procedures to help decrease resultant complications and improve outcomes.

Original languageEnglish
Pages (from-to)543-547
Number of pages5
JournalJournal of Urology
Volume193
Issue number2
DOIs
StatePublished - Feb 1 2015

Bibliographical note

Publisher Copyright:
© 2015 American Urological Association Education and Research, Inc.

Keywords

  • antibiotic prophylaxis
  • drug resistance, bacterial
  • physicians practice patterns
  • quality of health care
  • urologic surgical procedures

ASJC Scopus subject areas

  • Urology

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