Pd10-10 Pre-Operative Urine Testing Strategy and Infection After Ureteroscopy: Results From a Quality Improvement Collaborative

You have accessJournal of UrologyStone Disease: Surgical Therapy (including ESWL) II (PD10)1 May 2024PD10-10 PRE-OPERATIVE URINE TESTING STRATEGY AND INFECTION AFTER URETEROSCOPY: RESULTS FROM A QUALITY IMPROVEMENT COLLABORATIVE Dima Raskolnikov, Stephanie Daignault-Newton, Jerison Ross, Kara L. Watts, Alex C. Small, Casey Dauw, Khurshid Ghani, and for the Michigan Urological Surgery Improvement Collaborative Dima RaskolnikovDima Raskolnikov , Stephanie Daignault-NewtonStephanie Daignault-Newton , Jerison RossJerison Ross , Kara L. WattsKara L. Watts , Alex C. SmallAlex C. Small , Casey DauwCasey Dauw , Khurshid GhaniKhurshid Ghani , and for the Michigan Urological Surgery Improvement Collaborative View All Author Informationhttps://doi.org/10.1097/01.JU.0001008748.59024.cb.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgical management of stones guidelines from the American Urological Association recommend urinalysis (UA) before ureteroscopy (URS), and urine culture (UC) only if there are clinical or laboratory signs of urinary tract infection (UTI). Some surgeons believe that UA testing alone is insufficient. In the absence of evidence cited in the guidelines, or any large scale real-world practice data on this subject, we sought to characterize post-operative UTI rates and perioperative antibiotic prescribing patterns based on pre-operative urine testing for URS in a surgical collaborative. METHODS: We identified patients undergoing URS for stones using the Michigan Urological Surgery Improvement Collaborative prospective clinical registry between January 2021 and July 2023. Data abstractors collect information on UA/UC performed within 60 days of URS, prescription for pre-operative and post-operative antibiotics, post-operative UTI, and sepsis. Multivariable logistic regression was used to assess the association between UTI and UA and/or UC testing groups adjusting for patient and surgery factors and antibiotic use. RESULTS: 15,528 URS procedures were performed across 32 practices. Pre-operative urine testing was performed in 13,975 patients. Of this cohort, UA was done in 5,084 (36%), UC only in 819 (6%), and both UA/UC in 8,072 (58%) patients. Testing with UA only, when positive, was associated with lower rates of pre-operative antibiotic prescription than was positive testing with UC or UA/UC (54% vs. 82% vs 81% , p=<0.001), but similar rates of post-operative antibiotics. Post-operative UTI was more common in patients initially tested with UA/UC than those tested with UA alone (2.2 vs. 1.3%, p<0.001; Table 1). This difference was not statistically significant after controlling for pre- and post-operative antibiotic use and patient characteristics. CONCLUSIONS: Pre-operative testing with UA only is not associated with an increased risk of UTI or sepsis following URS as compared to UC only or both UA/UC. Our findings validate the AUA guidelines. Source of Funding: Blue Cross Blue Shield of Michigan © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e189 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Dima Raskolnikov More articles by this author Stephanie Daignault-Newton More articles by this author Jerison Ross More articles by this author Kara L. Watts More articles by this author Alex C. Small More articles by this author Casey Dauw More articles by this author Khurshid Ghani More articles by this author for the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...