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Protocol reduces antibiotic use prior to cytoscopy

Dec. 7, 2017, 9:23 AM


A study from Vanderbilt University Medical Center (VUMC) by Justin Gregg, MD, and colleagues demonstrates how a clinical protocol can help reduce unnecessary use of outpatient antibiotics.

Justin Gregg, MD

Urologic surgeons and infectious diseases specialists at VUMC wrote and implemented a protocol for the use of prophylactic antibiotics in patients undergoing cystoscopy, an outpatient procedure urologists use to examine a patient’s bladder that involves threading a thin flexible tube fitted with a miniature scope through the urethra.

With use of the protocol, antibiotic prescribing for cystoscopy patients decreased from 95 to 70 percent, while rates of post-cystoscopy urinary tract infection (UTI) remained unchanged at approximately 3 percent. The study will appear in an upcoming edition of the Journal of Urology.

“Antibiotic stewardship is critical given increased resistance rates associated with antibiotic overuse and relative declines in worldwide antibiotic development,” said Gregg, formerly a urologic surgery resident at VUMC and now a urologic oncology fellow at MD Anderson Cancer Center in Houston.

As groundwork for the protocol, the team gathered two years of VUMC clinical lab data to examine local patterns of antibiotic resistance among urology outpatients. An overwhelming majority of urologists at VUMC had been using fluoroquinolone antibiotics for prophylaxis for cystoscopy, but the lab data prompted the team to select an alternative drug, intramuscular ceftriaxone, for the protocol.

Next, to arrive at a concise UTI risk stratification algorithm to guide clinicians, the team consulted published guidelines as well as results from a prior Vanderbilt study of UTI after cystoscopy.

Finally, to evaluate their protocol the team looked for UTI in the VUMC electronic medical records of 1,245 cystoscopy patients, half treated before the January 2016 implementation of the protocol and half treated afterward.

Gregg was joined in the study by Rohan Bhalla, J. Paul Cook, Caroline Kang, MD, PhD, Roger Dmochowski, MD, MMgt, Thomas Talbot III, MD, MPH, and Daniel Barocas, MD, MPH. The study was supported in part by a grant from the National Institutes of Health (TR000445).

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