title: Should antibiotics be given prior to outpatient cystoscopy? A plea to urologists to practice antibiotic stewardship.
abstract: BACKGROUND
  Antimicrobial resistance is a major health problem, caused primarily by overuse of antibiotics in clinical situations in which they are not necessary. Practice guidelines recommend that antibiotics be given before outpatient cystoscopy to prevent symptomatic urinary tract infection (UTI).
  
  
  OBJECTIVE
  To determine the frequency of febrile UTI after outpatient flexible cystoscopy in antibiotic-naive bladder tumor patients.
  
  
  METHODS
  A total of 2010 consecutive outpatients with bladder tumors were entered into a prospective registry study. All patients underwent cystoscopy after they submitted a voided urine sample for culture. Significant bacteriuria was defined as >10(4) colony-forming units per milliliter with a single organism. Patients were stratified for known risk factors for UTI.
  
  
  METHODS
  Patients underwent flexible cystoscopy and received no antibiotics immediately before or after cystoscopy. They were followed for 30 d for onset of febrile UTI.
  
  
  METHODS
  The end point was incidence of febrile UTI within 30 d of cystoscopy. Febrile UTI was defined as temperature >38°C and dysuria, or having received antibiotics from an outside physician for urinary symptoms.
  
  
  CONCLUSIONS
  Of the 2010 patient cystoscopies, 489 (24%) had asymptomatic bacteriuria, and 1521 (76%) had sterile urine. Thirty-nine patients (1.9%) developed febrile UTI ≤30 d after cystoscopy-4.5% in colonized patients and 1.1% in uninfected patients (p=0.02). All UTIs resolved in ≤12-24h with oral antibiotics. None of the patients was admitted for bacterial sepsis. Limitations of the study are that it is a single-surgeon experience in one institution, and results may not apply to other patient populations.
  
  
  CONCLUSIONS
  Antibacterial therapy before outpatient flexible cystoscopy does not appear necessary in bladder tumor patients who have no clinical signs or symptoms of acute UTI, including asymptomatic bacteriuria. Antibiotic stewardship is the responsibility of all urologists.
authors.affiliation: Department of Urology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA. Electronic address: herrh@mskcc.org.
authors.forename: Harry W
authors.initials: HW
authors.lastname: Herr
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000592:standards*; D003558:Cystoscopy / Q000592:standards*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control*; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000517:prevention & control*; D014572:Urology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Bacteriuria; Cystoscopy; Urinary tract infection