Journal article
Post-procedural Antibiotic Use and Associated Outcomes After Common Urologic Procedures Across a National Healthcare System
Urology (Ridgewood, N.J.), Vol.171, pp.115-120
01/2023
DOI: 10.1016/j.urology.2022.10.014
PMID: 36334771
Abstract
To quantify the benefits and harms of post-procedural antibiotic use after common urologic procedures.
This retrospective cohort study included patients who underwent an endoscopic urologic procedure (transurethral resection of bladder tumor, transurethral resection of prostate, or ureteroscopy) within the Veterans Health Administration between January 1, 2017 and June 30, 2021. A post-procedural antibiotic was any qualifying antibiotic prescribed for administration on the day after the procedure. Guidelines generally do not recommend post-procedural antibiotics for surgical prophylaxis. Outcomes included unplanned return visits and Clostridioides difficile infection within 30 days. Log-binomial models with risk-adjustment were used to measure the association between post-procedural antibiotic use and outcomes. Hospital-level observed-to-expected (O:E) ratios were constructed to compare post-procedural antibiotic use.
There were 74,629 qualifying procedures across 105 hospitals; 27,422 (36.7%) received post-procedural antibiotics (median 3 days, IQR 3-6). An unplanned return visit occurred in 20.2% of patients who received post-procedural antibiotics vs 17.2% who did not (adjusted RR 1.032, 95% CI 0.999-1.066). C. difficile infection was diagnosed in 0.27% vs 0.10% in those who received and did not receive post-procedural antibiotics (adjusted RR 1.67, 95% CI 1.13-2.45). The O:E ratio for post-procedural antibiotic use ranged from 0.46 among hospitals in the lowest-use quartile to 1.93 in the highest-use quartile.
Post-procedural antibiotics were frequently prescribed after urologic procedures with large inter-facility variability even after adjusting for case-mix differences. Post-procedural antibiotic use was associated with increased risk for C. difficile infection but not fewer unplanned return visits. Efforts to reduce guideline-discordant use of post-procedural antibiotics are needed.
Details
- Title: Subtitle
- Post-procedural Antibiotic Use and Associated Outcomes After Common Urologic Procedures Across a National Healthcare System
- Creators
- Bibiana A.R. Granado - Iowa City VA Health Care SystemBruce Alexander - Department of Pharmacy, Iowa City Veterans Affairs Health Care System, Iowa City, IARyan L. Steinberg - University of IowaVignesh T. Packiam - University of IowaBrian C. Lund - Department of Pharmacy, Iowa City Veterans Affairs Health Care System, Iowa City, IADaniel J. Livorsi - Department of Pharmacy, Iowa City Veterans Affairs Health Care System, Iowa City, IA
- Resource Type
- Journal article
- Publication Details
- Urology (Ridgewood, N.J.), Vol.171, pp.115-120
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.urology.2022.10.014
- PMID
- 36334771
- ISSN
- 0090-4295
- eISSN
- 1527-9995
- Grant note
- the Iowa City VA Health Care System Department of Pharmacy Services and the Veterans Health Administration Health Services Research and Development Service BCL, CIN 13-412; DJL CDA 16-204 / Merck Investigator Studies Program
- Language
- English
- Electronic publication date
- 11/02/2022
- Date published
- 01/2023
- Academic Unit
- Pharmacy; Psychiatry; Infectious Diseases; Epidemiology; Urology; Internal Medicine
- Record Identifier
- 9984319985802771
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