Buck Matthew B, Smani Shayan, Nguyen Justin, Abello Alejandro, Jalfon Michael, Lokeshwar Soum D, Leapman Michael S, Cavallo Jaime A, Kenney Patrick A
Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Yale School of Medicine, New Haven, CT, USA.
World J Urol. 2025 Apr 29;43(1):257. doi: 10.1007/s00345-025-05642-0.
Urinary tract infections (UTI) are a common complication following office-based lower urinary tract procedures. While the American Urological Association (AUA) provides guidelines on antibiotic prophylaxis in this setting, significant practice variability remains. We implemented a standardized approach to antibiotic prophylaxis for office-based lower tract procedures through a nursing-driven algorithm. We hypothesized that a risk-adapted approach would reduce prophylactic antibiotic utilization and practice variability without increasing febrile UTI rates.
We conducted a pre-post study to examine the protocol's effects on antibiotic usage, abnormal urinalysis, and UTI rates. In February 2019 we implemented a clinical decision-support algorithm based on the AUA guidelines within our regional healthcare network. For office-based cystoscopy or urodynamics, nurses employed a standardized protocol to assess patient and procedural risk factors and administer single-dose 3 g oral fosfomycin to eligible patients.
12,909 patients had office-based procedures from March 2017 to December 2020, of whom 7,711 were treated after implementation of the nursing pathway. While overall antibiotic prophylaxis usage declined after implementation (-9.4%, p < 0.001), changes varied by site of practice. Frequency of prophylaxis decreased at the site with the highest baseline use (absolute change: -30.7% from pre to post-intervention, relative change: -61.0%) and increased at the site with the lowest baseline (absolute change: +14.9%, relative change: +46.8%). Following implementation, no changes in the occurrence of UTI were observed (+ 0.04%, p = 0.65).
Operationalizing a standardized antibiotic prophylaxis pathway for office-based cystourethroscopy and urodynamics reduced practice-level variation in antibiotic administration across a regional healthcare system. Despite an overall reduction in the use of antibiotic prophylaxis, there was no increase post-procedural febrile UTI rates.
尿路感染（UTI）是门诊下尿路手术后常见的并发症。虽然美国泌尿外科学会（AUA）针对这种情况提供了抗生素预防指南，但实际操作仍存在显著差异。我们通过一种由护理驱动的算法，对门诊下尿路手术的抗生素预防实施了标准化方法。我们假设，一种风险适应性方法将减少预防性抗生素的使用和实际操作差异，同时不会增加发热性UTI的发生率。
我们进行了一项前后对照研究，以检查该方案对抗生素使用、尿液分析异常和UTI发生率的影响。2019年2月，我们在区域医疗网络内实施了基于AUA指南的临床决策支持算法。对于门诊膀胱镜检查或尿动力学检查，护士采用标准化方案评估患者和手术风险因素，并为符合条件的患者给予单剂量3克口服磷霉素。
2017年3月至2020年12月期间，12909例患者接受了门诊手术，其中7711例在实施护理路径后接受治疗。实施后，总体抗生素预防使用率下降（-9.4%，p<0.001），但不同医疗机构的变化有所不同。预防频率在基线使用率最高的机构下降（绝对变化：干预前至干预后为-30.7%，相对变化：-61.0%），在基线使用率最低的机构上升（绝对变化：+14.9%，相对变化：+46.8%）。实施后，未观察到UTI发生率的变化（+0.04%，p=0.65）。
为门诊膀胱尿道镜检查和尿动力学检查实施标准化抗生素预防路径，减少了区域医疗系统中抗生素给药在实际操作层面的差异。尽管预防性抗生素的使用总体有所减少，但术后发热性UTI的发生率并未增加。
