Mp46-15 a Quality Improvement Initiative Improved Antibiotic Stewardship for Patients Undergoing Bladder Outlet Surgery

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology III (MP46)1 May 2024MP46-15 A QUALITY IMPROVEMENT INITIATIVE IMPROVED ANTIBIOTIC STEWARDSHIP FOR PATIENTS UNDERGOING BLADDER OUTLET SURGERY Sai Allu, Mohammed Yousufuddin, Borivoj Golijanin, Samuel Eaton, Gyan Pareek, and Elias Hyams Sai AlluSai Allu , Mohammed YousufuddinMohammed Yousufuddin , Borivoj GolijaninBorivoj Golijanin , Samuel EatonSamuel Eaton , Gyan PareekGyan Pareek , and Elias HyamsElias Hyams View All Author Informationhttps://doi.org/10.1097/01.JU.0001008668.53858.38.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients undergoing bladder outlet surgery often have an indwelling catheter, are on clean intermittent catheterization, and/or have asymptomatic bacteriuria. Infectious disease guidelines recommend only perioperative prophylaxis for these patients to reduce over-exposure to antibiotics without increasing risk of infectious events. Prior work at our institution has shown inappropriate extended use of prophylactic antibiotics for these patients. We evaluated the effectiveness of a quality improvement (QI) intervention to improve antibiotic stewardship for patients undergoing bladder outlet surgery. METHODS: A single-institution, retrospective review was performed to identify patients who underwent a TURP, Greenlight PVP, or ThuLEP from 2020 to 2023. The intervention date was June 6th, 2022; this included a presentation of the nature and rationale of the initiative to give only perioperative prophylaxis to these patients, with periodic reminders in conference and by email over subsequent months. Presence of a preoperative indwelling catheter or CIC regimen, preoperative urine cultures and antibiotics prescribed, and 30-day re-presentation secondary to an infection were recorded. Appropriate preoperative antibiotic use was measured using McNemar's test. RESULTS: 324 patients (median age 71 years) underwent 352 bladder outlet procedures, including TURP (54.3%), Greenlight PVP (24.1%), and ThuLEP (21.6%). There were 226 procedures performed pre-QI era while 126 procedures were performed post-QI. There was no difference in the percentage of catheterized patients (34.5% vs 43.5%, p>0.05). In the pre-QI time period, McNemar's test showed a significant difference in the rates of preoperative antibiotic use compared to the rate of positive urine culture (33.1% vs 28.8%, p=0.013). 17.7% of antibiotic prescriptions were prescribed inappropriately (additional pre- or postoperative courses). In the post-QI time period, McNemar's test showed no significant difference in the rates of preoperative antibiotic use compared to the rate of positive urine culture (34% vs 33.3%, p=1.0). Only 3.1% of antibiotics were prescribed inappropriately. The rate of postoperative hospital readmission is similarly low between time periods (2.2% vs 2.3%, p>0.05). CONCLUSIONS: A simple QI intervention reduced inappropriate and extended antibiotic prophylaxis for patients undergoing bladder outlet surgery, including those with ostensibly increased clinical risks of infection. Identifying areas for practice improvement and straightforward but systematic interventions can improve the quality of care, in this case by improving antibiotic stewardship. Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e758 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Sai Allu More articles by this author Mohammed Yousufuddin More articles by this author Borivoj Golijanin More articles by this author Samuel Eaton More articles by this author Gyan Pareek More articles by this author Elias Hyams More articles by this author Expand All Advertisement PDF downloadLoading ...