Lipsky Michael J, Sayegh Christopher, Theofanides Marissa C, Benson Mitchell C, Cooper Kimberly L
Department of Urology, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY.
Department of Urology, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY.
Urology. 2017 Dec;110:121-126. doi: 10.1016/j.urology.2017.06.058. Epub 2017 Aug 31.
To compare postoperative infectious outcomes of bladder biopsies performed in the office without antibiotic prophylaxis vs those done with preoperative antibiotic prophylaxis in the operating room (OR).
Our institutional review board-approved database was retrospectively reviewed for patients who underwent bladder biopsy in the office or in the OR between July 2014 and August 2015. All patients with bladder biopsies performed in the OR and none in the office received preoperative antibiotic prophylaxis. Patient characteristics and post-procedural outcomes including bacteriuria, urinary tract infection (UTI), and febrile UTI were recorded. The rates of these outcomes were compared between the 2 groups using the chi-square test. Patients were excluded from analysis if they experienced a UTI or were prescribed antibiotics within 30 days before their procedure.
In all, 216 biopsies were identified (106 in the office and 110 in the OR). No difference was noted in the rate of UTI (0.94% vs 0.91%, P = .98), or febrile UTI (0% vs 0.91%, P = .33) between those undergoing bladder biopsy in the office and those in the OR. There was no difference in the incidence of new urinary symptoms (2.8% vs 5.5%, P = .33) or post-procedural bacteriuria (3.8% vs 3.6%, P = .96).
Since the introduction of the mandated use of antibiotics for routine procedures such as bladder biopsy, antibiotic use has markedly increased. Our data suggest that the preoperative antibiotic prophylaxis that is recommended may not confer benefit to select patients. At a time when antibiotic stewardship is of utmost importance, guidelines regarding its use should be reconsidered.
比较在门诊不进行抗生素预防与在手术室（OR）进行术前抗生素预防的膀胱活检术后感染结果。
对我们机构审查委员会批准的数据库进行回顾性研究，纳入2014年7月至2015年8月期间在门诊或手术室接受膀胱活检的患者。所有在手术室进行膀胱活检且门诊未进行活检的患者均接受术前抗生素预防。记录患者特征及术后结果，包括菌尿症、尿路感染（UTI）和发热性UTI。使用卡方检验比较两组的这些结果发生率。如果患者在手术前30天内发生UTI或被开具抗生素，则排除在分析之外。
共识别出216例活检（门诊106例，手术室110例）。门诊进行膀胱活检的患者与手术室进行活检的患者在UTI发生率（0.94%对0.91%，P = 0.98）或发热性UTI发生率（0%对0.91%，P = 0.33）方面无差异。新出现的泌尿系统症状发生率（2.8%对5.5%，P = 0.33）或术后菌尿症发生率（3.8%对3.6%，P = 0.96）也无差异。
自从强制要求在膀胱活检等常规手术中使用抗生素以来，抗生素的使用显著增加。我们的数据表明，推荐的术前抗生素预防可能对特定患者无益处。在抗生素管理至关重要的当下，应重新考虑其使用指南。
