Rising Significance of Antibiotic Stewardship in Urology and Urinary Tract Infections

A Rapid Review

Laila Schneidewind; Jennifer Kranz; Zafer Tandogdu

Disclosures

Curr Opin Urol. 2021;31(4):285-290. 

In This Article

Abstract and Introduction

Abstract

Purpose of Review: To give an overview of the significance as well as recent developments in antibiotic stewardship (ABS) in urology and for the treatment of urinary tract infections (UTI). This rapid review is focused on recent publications during the past 18 months.

Recent Findings: Despite the evidence to support the use of ABS interventions in the treatment of UTIs, there remains considerable inappropriate use of antibiotics, up to 68%, especially concerning the treatment of asymptomatic bacteriuria and the overuse of fluoroquinolones. Emerging evidence indicate that ABS programs can improve patient outcome and reduce multidrug-resistant pathogens.

Interestingly, in this past 18 months new targets for ABS have been developed, e.g. involvement of a pharmacist, strict adherence to guidelines, improvement of the guidelines itself and understanding the prescription process in the emergency room as well as the analysis of own surveillance data.

Summary: ABS programs in urology are essential and their significance has become more apparent than ever before. New targets for ABS interventions should be evaluated in prospective controlled clinical trials of their effectiveness to reduce further inappropriate antibiotic use without hindering the treatment of UTIs.

Introduction

Urinary tract infections (UTIs) account for one of the most frequent bacterial infectious diseases in humans, in the outpatient setting as well as during inpatient treatment.[1] Epidemiological studies indicate that the prevalence of UTIs in urology is much higher than in other medical specialties.[2,3] Nosocomial infections in other medical specialties are mostly dominated by catheter associated infections, whereas in urology this can be directly related to the nature of the surgical procedures, which involve the urinary tract.[4–7] With antibiotic resistance on the rise these infections are becoming harder to treat and create major challenges. These include increased patient morbidity and mortality as well as higher costs to healthcare systems worldwide. As a means to tackle antibiotic resistance, antibiotic stewardship (ABS) programs in urology and for the treatment of UTI have become more important than before.[5,8,9] ABS programs promote the appropriate use of antibiotics, improve patient outcomes, reduce microbial resistance,[10] and decrease the spread of infections caused by multidrug-resistant organisms.[11] These programs involve enforcement and monitoring of adherence to relevant evidence-based guidelines on antibiotic use, which can have patient benefits and can lead to significant cost reductions. For instance, Cai et al. demonstrated in their prospective study that adherence to European Association of Urology guidelines on prophylactic antibiotics reduce antibiotic usage without increasing postoperative infection rates and lower the prevalence of resistant uro-pathogens.[10,12] In summary ABS is an important tool in tackling antibiotic resistant UTIs.

We conducted a rapid review of ABS of UTIs in urology focused on the publications during the past 18 months (until end of September 2020), focusing on the current evidence and new developments. We searched MEDLINE and the Cochrane Central Register of Controlled Trials with the MESH terms 'urology' or 'urinary tract infection' in the combination with 'antibiotic stewardship'. To ensure that we only include new aspects and development, we choose merely primary research articles and systematic review. Narrative reviews and letters to the editor were excluded. On the whole, we summarize new information and developments in ABS in urology as well as UTI.

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