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You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder I (MP25)1 Sep 2021

MP25-15 ANTIMICROBIAL SELECTION FOR TRANSURETHRAL PROCEDURE PROPHYLAXIS ACROSS THE UNITED STATES: A STATE-BY-STATE SURVEY OF ANTIBIOGRAMS

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    INTRODUCTION AND OBJECTIVE:

    The American Urological Association has developed recommendations for antimicrobial prophylaxis in urological procedures, most recently updated in 2019. These include empirical recommendations, with the caveat that physicians should rely on local antibiograms when possible. We sought to examine the susceptibility of common microbial culprits of post-transurethral procedure infection to the empirical recommendations using antibiograms across the United States.

    METHODS:

    We sought one antibiogram from each state. We started with an internet search for a state-level antibiogram and contacted the department of health (or similar) of each state if that wasn’t available. We next turned to the flagship public institution(s) of each state and subsequently contacted program directors of all infectious disease fellowship programs in every state for which we still did not have an antibiogram. Lastly, we searched the internet for antibiograms from any entity in remaining states. We abstracted all data into a database and favored adult and urinary sources when multiple were available. We used the Kruskal-Wallis test to compare susceptibility between antibiotics with a significance level of 0.05.

    RESULTS:

    Data was identified from 40 states with statewide data for 22, flagship data for 15, private institutional data for 2, and county data for 1. We focused on aminoglycosides, first gen. cephalosporins, third gen. cephalosporins, fluoroquinolones, and penicillin combinations. There were statistically significant differences in susceptibility of Escherichia coli (Figure 1), Klebsiella sp., methicillin sensitive Staphylococcus aureus, and Proteus mirabilis (all p<0.001).

    CONCLUSIONS:

    There is variability in susceptibility of urinary microbes to antimicrobials. First-line empirical recommendations include trimethoprim-sulfamethoxazole and cefazolin. In many states both provide poor coverage (ex: Washington state, 66 and 64%, respectively). Antimicrobial prophylaxis in urological surgery has the potential to prevent harm. Current empirical recommendations may not provide high-level coverage. Urologists should consider local susceptibility patterns and use caution with broad empirical recommendations.

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    Source of Funding:

    NA

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