Data reveal low adherence to AUA guidelines for antimicrobial prophylaxis

"The radical cystectomy with ileal conduit is a surgery that's notorious for having infectious complications," said Megan Prunty, MD.

In the following interview, Megan Prunty, MD, discusses the findings from her recent study looking at adherence to American Urological Association (AUA)-provided guidelines for administering antimicrobial prophylaxis for patients undergoing radical cystectomy with ileal conduit.¹ Prunty is a urology resident at University Hospitals through the Case Western University Urology Institute in Cleveland, Ohio.

Could you describe the background for this study?

As urologists, we rely on the AUA guidelines to help us choose antibiotics for surgery. The radical cystectomy with ileal conduit is a surgery that's notorious for having infectious complications. The last time adherence to AUA guidelines was evaluated for radical cystectomy was using data that only went to 2013. So, it's been almost a decade since that was evaluated, and [we] wanted to see if we, as a specialty, were doing any better with adherence to guidelines and go from there.

What were some of your notable findings? Were any of those surprising to you and your coauthors?

The previous group who had looked at this saw a 15% adherence to the AUA guidelines up to 2013. We're doing better, but not much better. We have about 28% adherence to the guidelines.

AUA guidelines recommend less than 24 hours of antibiotics. They have 4 recommended options, with Ancef [cefazolin] being the primary recommendation. We had 28% adherence as a group to the AUA guidelines. Most often, the violations were from extended duration antibiotics, so keeping patients on antibiotics longer than 24 hours. We also saw that there were some unusual regimens that may have been patient-specific, but were deviating from the recommendations.

Is any further research on this topic planned? If so, what will that focus on?

There is a little bit of research that could be done in the future regarding this topic. There's a lot of research into the microbiome of the bladder and in relation to bladder cancer, so there's a huge opportunity to research patient-specific antibiotic recommendations, looking into the microbiome and looking into antifungal use for radical cystectomy. There's a huge amount of potential that we could move forward with.

What is the take-home message for practicing urologists based on this study?

For practicing urologists, a very quick take-home would be that it is safe to give 24 hours or less of antibiotics for radical cystectomy. It does not decrease your infectious complications to have extended duration antibiotics, according to our limited data. As a group, if we could have more education or outreach on antibiotic stewardship, I think that would be helpful. That would be another next step that we as practicing urologists could take away.

Reference

1. Prunty M, Rhodes S, Rivero MJ, et al. National adherence to guidelines for antimicrobial prophylaxis for patients undergoing radical cystectomy. J Urol. November 16, 2022. Accessed December 7, 2022. doi:10.1097/JU.0000000000003069