Cameron Anne P, Campeau Lysanne, Brucker Benjamin M, Clemens J Quentin, Bales Gregory T, Albo Michael E, Kennelly Michael J
Department of Urology, University of Michigan, Ann Arbor, Michigan.
Jewish General Hospital E959, Montreal, Québec, Canada.
Neurourol Urodyn. 2017 Apr;36(4):915-926. doi: 10.1002/nau.23253. Epub 2017 Mar 27.
Antibiotic prophylaxis before urodynamic testing (UDS) is widely utilized to prevent urinary tract infection (UTI) with only limited guidance. The Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) convened a Best Practice Policy Panel to formulate recommendations on the urodynamic antibiotic prophylaxis in the non-index patient.
Recommendations are based on a literature review and the Panel's expert opinion, with all recommendations graded using the Oxford grading system.
All patients should be screened for symptoms of UTI and undergo dipstick urinalysis. If the clinician suspects a UTI, the UDS should be postponed until it has been treated. The first choice for prophylaxis is a single oral dose of trimethoprim-sulfamethoxazole before UDS, with alternative antibiotics chosen in case of allergy or intolerance. Individuals who do NOT require routine antibiotic prophylaxis include those without known relevant genitourinary anomalies, diabetics, those with prior genitourinary surgery, a history of recurrent UTI, post-menopausal women, recently hospitalized patients, patients with cardiac valvular disease, nutritional deficiencies or obesity. Identified risk factors that increase the potential for UTI following UDS and for which the panel recommends peri-procedure antibiotics include: known relevant neurogenic lower urinary tract dysfunction, elevated PVR, asymptomatic bacteriuria, immunosuppression, age over 70, and patients with any indwelling catheter, external urinary collection device, or performing intermittent catheterization. Patients with orthopedic implants have a separate risk stratification.
These recommendations can assist urodynamic providers in the appropriate use of antibiotics for UDS testing. Clinical judgment of the provider must always be considered.
尿动力学检查（UDS）前使用抗生素预防措施广泛用于预防尿路感染（UTI），但指导有限。尿动力学、女性盆底医学与泌尿生殖重建学会（SUFU）召集了一个最佳实践政策小组，以制定关于非索引患者尿动力学抗生素预防的建议。
建议基于文献综述和小组的专家意见，所有建议均采用牛津分级系统进行分级。
所有患者均应筛查UTI症状并进行尿试纸条尿液分析。如果临床医生怀疑有UTI，应推迟UDS检查，直至UTI得到治疗。预防的首选是在UDS检查前口服一剂复方新诺明，如有过敏或不耐受情况则选择其他抗生素。不需要常规抗生素预防的人群包括那些没有已知相关泌尿生殖系统异常的人、糖尿病患者、有过泌尿生殖系统手术史的人、复发性UTI病史者、绝经后妇女、近期住院患者、患有心脏瓣膜病、营养缺乏或肥胖的患者。已确定的增加UDS检查后UTI可能性且小组建议围手术期使用抗生素的危险因素包括：已知相关神经源性下尿路功能障碍、残余尿量升高、无症状菌尿、免疫抑制、70岁以上以及任何留置导尿管、外置尿液收集装置或进行间歇性导尿的患者。有骨科植入物的患者有单独的风险分层。
这些建议可协助尿动力学检查人员合理使用抗生素进行UDS检查。必须始终考虑检查人员的临床判断。
