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Tailored perioperative antimicrobial prophylaxis in urological surgery: myth or reality?
2017 (English)In: Current Opinion in Urology, ISSN 0963-0643, E-ISSN 1473-6586, Vol. 27, no 2, 112-119 p.Article, review/survey (Refereed) Published
Abstract [en]

Purpose of review The controversies surrounding perioperative antimicrobial prophylaxis (AMP) are about the use and especially misuse of antibiotics. The overall lack of evidence to facilitate a rational perioperative AMP policy in urological surgery and the postoperative infectious complications remain a challenge. Therefore, a basic tool to aid decision-making would be useful. A model based on the patients' risk factors, the level of contamination and grading of surgical procedures is discussed. Recent findings A series of studies have shown that infectious complications and healthcare-associated infections remain consistently at an average of 10%, with a great variation in frequency dependent on the patients' preoperative status and the type, severity and contamination level of the surgical procedure. Preoperative patient assessment and preparation are key factors for well tolerated surgery and recovery. Adherence to the guidelines appears to reduce both the prescription of antimicrobials and the total costs without risking the patient outcome. Several studies of a series of interventions such as cystoscopy, endoscopic stone surgery and selected clean-contaminated interventions give support to the model. Bacteriuria, upgrading the patient to the contaminated level, requires preoperative control. Summary The discussed model assists the urologists in decision-making on perioperative AMP and contributes to a responsible use of antibiotics.

Place, publisher, year, edition, pages
2017. Vol. 27, no 2, 112-119 p.
Keyword [en]
antibiotic prophylaxis, antimicrobial stewardship programme, endourological surgery, microbial sistance, perioperative antimicrobial prophylaxis, risk factors, urological surgery
National Category
Urology and Nephrology
Identifiers
URN: urn:nbn:se:umu:diva-132623DOI: 10.1097/MOU.0000000000000363ISI: 000393775800005PubMedID: 27861259OAI: oai:DiVA.org:umu-132623DiVA: diva2:1130599
Available from: 2017-08-10 Created: 2017-08-10 Last updated: 2017-08-10Bibliographically approved

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Lundström, Karl-Johan
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  • nn-NB
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