Antibiotic prophylaxis Flashcards
which procedures for prophylaxis and levels of evidence
TRUS yes 1a flexi no 1a eswl no 1a uds no 1a catheter no level 4 SNM level 4 yes
which procedures for prophylaxis and levels of evidence trus felxi eswl uds catheter nephrostomy change
TRUS yes 1a flexi no 1a eswl no 1a uds no 1a catheter no level 4 nephrostomy replacement level 4 yes
zani review 19 RCT cochrane 2011
19 RCT 3599 patients
all outcomes favoured abx use
no data confirm 3 days superior short course or that multiple dose superior to single dose
cystoscopy abx flexi paper
Herr Eur Urol 2014
end point febrile uti 30 days
2010 patient cysto
24% had ASB
1.9% developed febrile uti
4.5% in colonised patients and 1.1% in uninfected patients
all uti resolved 12-24 hours, non admitted
conclusio - not needed if no signs nor asb
UDS and abx cochrane review
Foon 2012 9 RCT no difference symptomatic uti NNT abx to prevent bacteriuria was 12.3 prophylaxis did not reduce risk bacteriuria
eswl and abx prophylaxis cochrane review
Lu 2012
proven sterile urine before treatment
9 trials
1364 patients
no sig difference rate fever, rate positive urine culture, uti
not necessary when no or low risk factors presented
wound classes I to IV I IIa IIb III IV V what abx dose required
I = clean - simple nephrectomy, scrotal surgery, no abx required, cystoscopy, UDS, diagnostic URS
IIa = clean contaminated urinary tract
PUJ, bladder surgery RP single dose, TURBT large tumour, TURP in men
IIb = clean contaminated bowel
single dose prior surgery
urinary diversion small intestine,
III contaminated, bowel surgery, large bowel urinary diversion, TURP men with catheter, TURBT necrosis, complicated stone, , control bacteriuria prior to surgery, single dose at surgery
consider prolonged regime
IV= dirty drainage abscess
