Antibiotic prophylaxis varies widely prior to stent removal

It may be time to take a closer look at antibiotic prophylaxis prior to ureteral stent removal, according to new data reported at the AUA annual meeting in Chicago.

Researchers reported that there appears to be significant variation in practice among urologists regarding antibiotic prophylaxis prior to stent removal, and that may be due to lack of quality evidence.

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“Without evidence to support this practice, patients may be exposed unnecessarily to harm related to antibiotic use without a clear benefit,” write the authors. They have found a lack of consensus among urologists, suggesting an urgent need for additional research and development of updated guidelines.

Claudia Berrondo, MD, of the University of Washington, Seattle, and colleagues conducted an anonymous online survey, which was distributed to members of the Endourological Society. The survey included questions concerning provider demographics and personal practices with ureteral stent use and removal. Urologists were also surveyed about antibiotic use prior to stent removal. Among the 2,544 urologists invited to participate, 284 (11%) completed the survey.

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The findings showed that 50% do not prescribe antibiotics while the stent is in place, and 52% prescribe a single-dose antibiotic prior to stent removal. The authors found significant variation in antibiotic prophylaxis with different methods of stent removal and surgeries leading to stent placement. A significant percentage of clinicians (43%) reported they do not routinely obtain a urine culture prior to stent removal. Among the clinicians who obtain a urine culture, duration of antibiotic treatment varied based on urine culture results.

“I think the survey indicates that urologists are relying on their own experience on how to proceed here,” said Christopher Saigal, MD, vice chair of urology at UCLA School of Medicine, Los Angeles.

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“In the absence of high-quality evidence for or against this practice, the guidelines may not be as authoritative as others based on strong evidence,” added Dr. Saigal, who was not involved with the study.

AUA guidelines recommend antibiotic prophylaxis in patients undergoing cystoscopy with manipulation (including ureteral stent removal). Strong evidence to support this practice for preventing urinary tract infections in this setting has been lacking. The survey showed that the main factors influencing antibiotic prophylaxis prior to ureteral stent removal are the AUA guidelines, clinical experience, patient history of UTI, and urine culture results.

“As we learn more about the harms of antibiotic use, including changes to the urinary microbiome and gut microbiome, such use may not be warranted in the absence of good evidence,” Dr. Saigal told Urology Times.

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