Adherence to European Association of Urology Guidelines on Prophylactic Antibiotics: An Important Step in Antimicrobial Stewardship

Background: The evolution of resistant pathogens is a worldwide health crisis and adherence to European Association of Urology (EAU) guidelines on antibiotic prophylaxis may be an important way to improve antibiotic stewardship and reduce patient harm and costs. Objective: To evaluate the prevalence of antibiotic-resistant bacterial strains and health care costs during a period of adherence to EAU guidelines in a tertiary referral urologic institution. Design, setting, and participants: A protocol for adherence to EAU guidelines for antibiotic prophylaxis for all urologic procedures was introduced in January 2011. Data for 3529 urologic procedures performed between January 2011 and December 2013 after protocol introduction were compared with data for 2619 procedures performed between January 2008 and December 2010 before protocol implementation. The prevalence of bacterial resistance and health care costs were compared between the two periods. Outcome measurements and statistical analysis: The outcome measures were the proportion of resistant uropathogens and costs related to antibiotic consumption and symptomatic postoperative infection. We used x2 and Fisher’s exact tests to test the significance of differences. Results and limitations: The proportion of patients with symptomatic postoperative infection did not differ (180/3529 [5.1%] vs 117/2619 [4.5%]; p = 0.27). A total of 342 isolates from all patients with symptomatic postoperative infections were analysed. The rate of resistance of Escherichia coli to piperacillin/tazobactam (9.1% vs 5.4%; p = 0.03), gentamicin (18.3% vs 11.2%; p = 0.02), and ciprofloxacin (32.3% vs 19.1%; p = 0.03) decreased significantly after protocol introduction. The defined daily dose (DDD) use of ciprofloxacin fell from 4.2 to 0.2 DDD per 100 patient-days after implementation (p < 0.001). Antibiotic drug costs (s76 980 vs s36 700) and costs related to postoperative infections (s45 870 vs s29 560) decreased following introduction of the protocol (p < 0.001).