title: Overuse of antimicrobial prophylaxis in community practice urology.
abstract: OBJECTIVE
  We examined index urological surgeries to assess utilization patterns of antimicrobial prophylaxis in a large, community based population.
  
  
  METHODS
  From the Premier Perspectives Database we identified patients who underwent inpatient urological surgeries that are considered index procedures by the ABU (American Board of Urology), including radical prostatectomy, partial or radical nephrectomy, radical cystectomy, ureteroscopy, shock wave lithotripsy, transurethral resection of the prostate, percutaneous nephrostolithotomy, transvaginal surgery, inflatable penile prosthesis, brachytherapy, transurethral resection of bladder tumor and cystoscopy. Procedures were identified based on ICD-9 procedure codes for 2007 to 2012. Antimicrobial administration, class and duration were abstracted from patient billing data. The class and duration of antimicrobials concordant with the 2008 AUA Best Practice Policy Statement was used to determine compliance.
  
  
  RESULTS
  The overall compliance rate was 53%, ranging from 0.6% for radical cystectomy to 97% for shock wave lithotripsy. Antimicrobial use consistent with AUA Best Practices included the appropriate class in 67% of cases (range 34% to 80%) and the recommended duration in 78% (range 1.2% to 98%). Average prophylaxis duration for procedures for which it is recommended ranged from 1.1 days after brachytherapy to 10.3 days after radical cystectomy. The compliance rate increased from 46% overall in 2007 to 59% overall in 2012.
  
  
  CONCLUSIONS
  We documented considerable variation in antimicrobial prophylaxis for urological surgery. Compliance with AUA Best Practices increased with time but overall rates remain less than 60%. Efforts are needed to better understand the reasons for variation from recommended antimicrobial prophylaxis for common inpatient urological procedures to help decrease resultant complications and improve outcomes.
authors.affiliation: Department of Urology, University of Washington and Division of Urology, Veterans Affairs Puget Sound Health Care System, Seattle, Washington. Electronic address: mnmoss@uw.edu.
authors.forename: Matthew
authors.initials: M
authors.lastname: Mossanen
authors.affiliation: Department of Urology, University of Washington and Division of Urology, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
authors.forename: Joshua K
authors.initials: JK
authors.lastname: Calvert
authors.affiliation: Department of Urology, University of Washington and Division of Urology, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Holt
authors.affiliation: Department of Urology, University of Washington and Division of Urology, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: James
authors.affiliation: Department of Urology, University of Washington and Division of Urology, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Wright
authors.affiliation: Department of Urology, University of Washington and Division of Urology, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Harper
authors.affiliation: Department of Urology, University of Washington and Division of Urology, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
authors.forename: John N
authors.initials: JN
authors.lastname: Krieger
authors.affiliation: Department of Urology, University of Washington and Division of Urology, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
authors.forename: John L
authors.initials: JL
authors.lastname: Gore
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D013520:Urologic Surgical Procedures; D014572:Urology
chemical_list: D000890:Anti-Infective Agents
keywords: antibiotic prophylaxis; bacterial; drug resistance; physician's practice patterns; quality of health care; urologic surgical procedures