Embedding locally tailored antimicrobial prophylaxis into standardized order sets for urological procedures reduces antimicrobial use

Introduction: Inappropriate selection and dosing of antimicrobial prophylaxis (AP) for urological procedures remain common. We therefore evaluated the impact of a locally adapted AP guideline, embedded within standardized pre-procedure order sets and supported by antimicrobial stewardship interventions, on antimicrobial utilization in a high-resistance setting. Methods: A 1-year study of the three phases-pre-intervention, intervention and after intervention-was performed at a tertiary care hospital in Thailand. The intervention included development of local AP guidelines based on the institutional antibiogram, integration into one-page order sets, multifaceted education and feedback. Antimicrobial utilization was assessed using days of therapy (DOT) per 1000 patient-days. Interrupted time series (ITS) analysis was used to evaluate changes in antimicrobial use over time. Postoperative urinary tract infections (UTIs) and surgical site infections (SSIs) within 30 days were monitored. ITS analysis demonstrated a significant immediate reduction in weekly total DOT per 1000 patient-days following intervention implementation (level change -3156.8; 95% CI -4604.7 to -1708.9), with no significant change in slope. The incidence of SSI and UTI remained below 1% across all periods. Conclusions: Implementation of locally tailored AP guidelines integrated into standardized order sets, supported by stewardship interventions, was associated with a substantial and sustained reduction in antimicrobial exposure for urological procedures. This approach is relevant to high-resistance, resource-limited settings.