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Prophylactic use of antimicrobials in commonly performed outpatient urologic procedures

Nature Clinical Practice Urology volume 3, pages 24–31 (2006)Cite this article

Abstract

An antimicrobial is an agent capable of killing or inhibiting the growth of a micro-organism. Antimicrobial prophylaxis encompasses efforts to prevent postprocedure infections through the use of an antimicrobial agent before, and, in some cases, for a limited time after a procedure. A thorough history and physical examination are essential to identify host factors that increase a patient's risk for postprocedural infection. Risk-modifying factors include age, anatomy, geographical area of residence, immune and nutritional status, cardiac valve integrity, prosthetic joints, the presence of indwelling hardware and distant infectious wounds. Prophylaxis for the most common urologic outpatient procedures can be attained with oral trimethoprim–sulfamethoxazole or fluoroquinolone administered between 2 h and 30 min before a procedure. Special consideration for the type and duration of prophylaxis should be given to patients with moderate to severe cardiac valvular conditions and recently inserted prosthetic joints.

Key Points

  • There are several local and systemic factors that increase the chances of a patient developing a postprocedure infection, including poor nutritional status, advanced age and compromised immunity; such risk-modifying factors influence not only the chance a patient has of developing an infection, but how serious the consequences of that infection might be

  • A number of adverse effects are associated with antimicrobial medications, ranging from gastrointestinal disturbances to allergic reactions; it is, therefore, important to consider patient factors when selecting an appropriate antimicrobial agent

  • A full medical history and physical examination should be conducted before deciding if antimicrobial prophylaxis is appropriate in order to identify whether a patient has any risk-modifying factors

  • Routine antimicrobial prophylaxis is not indicated in patients undergoing catheterization, cystoscopy or urodynamic investigations, but can be useful in some patients with risk-modifying factors

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Acknowledgements

Special thanks to AJ Schaeffer and ME Nielsen for critical reviews of the manuscript.

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  1. senior resident at the James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD, USA

    Edward M Schaeffer

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  1. Edward M Schaeffer
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Correspondence to Edward M Schaeffer.

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The author declares no competing financial interests.

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Schaeffer, E. Prophylactic use of antimicrobials in commonly performed outpatient urologic procedures. Nat Rev Urol 3, 24–31 (2006). https://doi.org/10.1038/ncpuro0357

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