Antibiotic prophylaxis after urethroplasty may offer no benefit

Adarsh Manjunath, Liqi Chen, Leah J Welty, Vincent J. Wong, Channa Amarasekera, Chris M. Gonzalez, Matthias Dominikus Hofer*

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Purpose: Patients often receive antibiotic prophylaxis after urethroplasty to minimize the risk of urinary tract infection (UTI). The aim of this study was to determine the frequency of UTIs after urethroplasty and its impact on urethral and incisional healing. Methods: Patients undergoing urethroplasty by a single surgeon from 2000 to 2012 were retrospectively reviewed. All patients received preoperative antibiotic prophylaxis and postoperative prophylaxis for 30 days or until catheter removal. We reviewed urine cultures obtained within 30 days after urethroplasty in symptomatic patients, and rates of stricture recurrence and wound complications. A positive culture was defined as > 1000 cfu/mL of an organism. Results: 398 patients were included with a mean age of 43.5 years at time of surgery. We identified 102 positive urine cultures (25.6%) within 30 days of urethroplasty. 78 stricture recurrences (19.6%) occurred at an average of 3 years after surgery and 18 (4.5%) experienced a wound complication, with a 52 month mean follow-up. There were no significant differences in stricture recurrence (p = 0.36) or wound complications (p = 0.42) between patients who had a positive and negative urine culture. On multivariate analysis, positive urine cultures (HR 1.0, 95% CI 0.6–1.8, p = 0.88) were not associated with stricture recurrence, while lichen sclerosis (HR 3.2, 95% CI 1.1–9.2, p = 0.03) and previous urethroplasty (HR 2.3, 95% CI 1.1–4.6, p = 0.03) were. Conclusion: Bacterial colonization and UTIs despite antimicrobial prophylaxis are common in urethroplasty patients. This, however, does not appear to impair urethral healing or influence wound healing, suggesting that postoperative prophylaxis may in fact offer no benefit.

Original languageEnglish (US)
JournalWorld journal of urology
DOIs
StatePublished - Jan 1 2019

Fingerprint

Antibiotic Prophylaxis
Pathologic Constriction
Urine
Recurrence
Wounds and Injuries
Lichen Sclerosus et Atrophicus
Urinary Tract Infections
Wound Healing
Multivariate Analysis
Catheters

Keywords

  • Antibiotic prophylaxis
  • Antimicrobial stewardship
  • Urethral stricture
  • Urinary tract infection

ASJC Scopus subject areas

  • Urology

Cite this

Manjunath, Adarsh ; Chen, Liqi ; Welty, Leah J ; Wong, Vincent J. ; Amarasekera, Channa ; Gonzalez, Chris M. ; Hofer, Matthias Dominikus. / Antibiotic prophylaxis after urethroplasty may offer no benefit. In: World journal of urology. 2019.
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title = "Antibiotic prophylaxis after urethroplasty may offer no benefit",
abstract = "Purpose: Patients often receive antibiotic prophylaxis after urethroplasty to minimize the risk of urinary tract infection (UTI). The aim of this study was to determine the frequency of UTIs after urethroplasty and its impact on urethral and incisional healing. Methods: Patients undergoing urethroplasty by a single surgeon from 2000 to 2012 were retrospectively reviewed. All patients received preoperative antibiotic prophylaxis and postoperative prophylaxis for 30 days or until catheter removal. We reviewed urine cultures obtained within 30 days after urethroplasty in symptomatic patients, and rates of stricture recurrence and wound complications. A positive culture was defined as > 1000 cfu/mL of an organism. Results: 398 patients were included with a mean age of 43.5 years at time of surgery. We identified 102 positive urine cultures (25.6{\%}) within 30 days of urethroplasty. 78 stricture recurrences (19.6{\%}) occurred at an average of 3 years after surgery and 18 (4.5{\%}) experienced a wound complication, with a 52 month mean follow-up. There were no significant differences in stricture recurrence (p = 0.36) or wound complications (p = 0.42) between patients who had a positive and negative urine culture. On multivariate analysis, positive urine cultures (HR 1.0, 95{\%} CI 0.6–1.8, p = 0.88) were not associated with stricture recurrence, while lichen sclerosis (HR 3.2, 95{\%} CI 1.1–9.2, p = 0.03) and previous urethroplasty (HR 2.3, 95{\%} CI 1.1–4.6, p = 0.03) were. Conclusion: Bacterial colonization and UTIs despite antimicrobial prophylaxis are common in urethroplasty patients. This, however, does not appear to impair urethral healing or influence wound healing, suggesting that postoperative prophylaxis may in fact offer no benefit.",
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author = "Adarsh Manjunath and Liqi Chen and Welty, {Leah J} and Wong, {Vincent J.} and Channa Amarasekera and Gonzalez, {Chris M.} and Hofer, {Matthias Dominikus}",
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Antibiotic prophylaxis after urethroplasty may offer no benefit. / Manjunath, Adarsh; Chen, Liqi; Welty, Leah J; Wong, Vincent J.; Amarasekera, Channa; Gonzalez, Chris M.; Hofer, Matthias Dominikus.

In: World journal of urology, 01.01.2019.

Research output: Contribution to journalArticle

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AU - Manjunath, Adarsh

AU - Chen, Liqi

AU - Welty, Leah J

AU - Wong, Vincent J.

AU - Amarasekera, Channa

AU - Gonzalez, Chris M.

AU - Hofer, Matthias Dominikus

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N2 - Purpose: Patients often receive antibiotic prophylaxis after urethroplasty to minimize the risk of urinary tract infection (UTI). The aim of this study was to determine the frequency of UTIs after urethroplasty and its impact on urethral and incisional healing. Methods: Patients undergoing urethroplasty by a single surgeon from 2000 to 2012 were retrospectively reviewed. All patients received preoperative antibiotic prophylaxis and postoperative prophylaxis for 30 days or until catheter removal. We reviewed urine cultures obtained within 30 days after urethroplasty in symptomatic patients, and rates of stricture recurrence and wound complications. A positive culture was defined as > 1000 cfu/mL of an organism. Results: 398 patients were included with a mean age of 43.5 years at time of surgery. We identified 102 positive urine cultures (25.6%) within 30 days of urethroplasty. 78 stricture recurrences (19.6%) occurred at an average of 3 years after surgery and 18 (4.5%) experienced a wound complication, with a 52 month mean follow-up. There were no significant differences in stricture recurrence (p = 0.36) or wound complications (p = 0.42) between patients who had a positive and negative urine culture. On multivariate analysis, positive urine cultures (HR 1.0, 95% CI 0.6–1.8, p = 0.88) were not associated with stricture recurrence, while lichen sclerosis (HR 3.2, 95% CI 1.1–9.2, p = 0.03) and previous urethroplasty (HR 2.3, 95% CI 1.1–4.6, p = 0.03) were. Conclusion: Bacterial colonization and UTIs despite antimicrobial prophylaxis are common in urethroplasty patients. This, however, does not appear to impair urethral healing or influence wound healing, suggesting that postoperative prophylaxis may in fact offer no benefit.

AB - Purpose: Patients often receive antibiotic prophylaxis after urethroplasty to minimize the risk of urinary tract infection (UTI). The aim of this study was to determine the frequency of UTIs after urethroplasty and its impact on urethral and incisional healing. Methods: Patients undergoing urethroplasty by a single surgeon from 2000 to 2012 were retrospectively reviewed. All patients received preoperative antibiotic prophylaxis and postoperative prophylaxis for 30 days or until catheter removal. We reviewed urine cultures obtained within 30 days after urethroplasty in symptomatic patients, and rates of stricture recurrence and wound complications. A positive culture was defined as > 1000 cfu/mL of an organism. Results: 398 patients were included with a mean age of 43.5 years at time of surgery. We identified 102 positive urine cultures (25.6%) within 30 days of urethroplasty. 78 stricture recurrences (19.6%) occurred at an average of 3 years after surgery and 18 (4.5%) experienced a wound complication, with a 52 month mean follow-up. There were no significant differences in stricture recurrence (p = 0.36) or wound complications (p = 0.42) between patients who had a positive and negative urine culture. On multivariate analysis, positive urine cultures (HR 1.0, 95% CI 0.6–1.8, p = 0.88) were not associated with stricture recurrence, while lichen sclerosis (HR 3.2, 95% CI 1.1–9.2, p = 0.03) and previous urethroplasty (HR 2.3, 95% CI 1.1–4.6, p = 0.03) were. Conclusion: Bacterial colonization and UTIs despite antimicrobial prophylaxis are common in urethroplasty patients. This, however, does not appear to impair urethral healing or influence wound healing, suggesting that postoperative prophylaxis may in fact offer no benefit.

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KW - Antimicrobial stewardship

KW - Urethral stricture

KW - Urinary tract infection

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