Is antibiotic prophylaxis required for flexible cystoscopy? A truncated randomized double-blind controlled trial. The Issue of Prophylactic Antibiotics prior to Flexible Cystoscopy Oral ciprofloxacin or trimethoprim reduces bacteriuria after flexible cystoscopy Efficacy of antibiotic prophylaxis in patients undergoing cystoscopy: a randomized clinical trial Urinary tract infection and patient satisfaction after flexible cystoscopy and urodynamic evaluation. Antibiotic prophylaxis in cystic fibrosis: inhaled cephaloridine as an adjunct to oral cloxacillin. Randomized clinical trial on antimicrobial prophylaxis for flexible urethrocystoscopy. Antibiotic prophylaxis in infants and young children with cystic fibrosis: a randomized controlled trial. [Antimicrobial prophylaxis in urethrocystoscopy. Comparative study]. Cystic fibrosis: antibiotic prescribing practices in the United Kingdom and Eire. Influence of broad-spectrum antibiotic prophylaxis on intracranial pressure monitor infections and subsequent infectious complications in head-injured patients. A selective antibiotic prophylaxis policy for laparoscopic cholecystectomy is effective in minimising infective complications. Adherence to international antimicrobial prophylaxis guidelines in cardiac surgery: a Jordanian study demonstrates need for quality improvement. Antibiotic prophylaxis in permanent pacemaker implantation: a prospective randomised trial. A tale of 2 hospitals: a staggered cohort study of targeted interventions to improve compliance with antibiotic prophylaxis guidelines. Prospective randomized comparative study of antibiotic prophylaxis in urethrocystoscopy and urethrocystography. Long-term follow-up of children with vesicoureteral reflux with and without antibiotic prophylaxis
PURPOSE To examine the incidence of  urinary tract infection ( UTI ) after flexible cystoscopy ( FC ) and determine whether prophylactic norfloxacin reduces this incidence compared with placebo . PATIENTS AND METHODS A double-blind trial was performed , r and omizing 234 patients to either 400 mg of norfloxacin or placebo prior to FC . All patients provided a midstream urine specimen ( MSU ) before the procedure , as well as at day 3 and day 7 after FC . In addition , a telephone question naire was performed to correlate the nature and severity of any symptoms associated with UTI . RESULTS Interim analysis was performed because of the low recruitment rate , and a significantly lower infection rate than expected meant that the trial was discontinued . There was one symptomatic UTI in the placebo group ( 0.82 % ) and one in the norfloxacin group ( 0.89 % ) . The UTI in the placebo group was de novo , while the infection in the norfloxacin group was secondary to pre-FC bacteriuria . There was no difference in the infection rates in the two groups . The overall infection rate ( de novo and secondary to existing bacteruria ) after FC was 0.85 % . CONCLUSION Infection after flexible cystoscopy is rare and not associated with significant morbidity . A much larger study would be required to determine whether antibiotic prophylaxis significantly reduces the rate of postprocedure UTI Objective : The aim of this study was to determine whether single – dose parenteral antibacterial therapy significantly alters the rate of infection in patients undergoing flexible cystourethroscopy . Patients and Methods : 162 patients were studied prospect ively having either received parenteral antibacterial chemoprophylaxis prior to flexible cystourethroscopy or not . Pre– and postprocedure mid stream sample s of urine ( MSSU ) were obtained to objective ly evaluate the presence of infection . Results : Gentamicin prophylaxis reduced the rate of post – cystoscopy – positive MSSUs from 21 to 5 % . Conclusion : The surprisingly high rate of infection after flexible cystoscopy was significantly reduced by a single dose of gentamicin To report a large prospect i ve , pragmatic , double‐blind r and omized controlled trial to determine whether oral prophylactic antibiotics reduce the risk of bacteriuria  after flexible cystoscopy ( FC ) , as up to 10 % of patients develop urinary infection afterwards , with significant morbidity and costs for health services Objective To establish the efficacy of antibiotic prophylaxis prior to cystoscopy in out patients in decreasing the incidence of post-procedure urinary tract infection . Study design and setting A r and omized clinical trial in patients ( men and women ) older than 18 who underwent cystoscopy for any non-urgent indication . The intervention was Levofloxacin 500 mg single dose , and the control was placebo 500 mg single dose made with similar characteristics . The primary outcome was urinary tract infection ( UTI ) measured 3–10 days after the procedure . It was performed as per protocol analysis . Results Hundred and thirty-eight patients in each study arm completed the trial . The incidence of UTI in the intervention group was 0.7 % and in the placebo group was 3 % ( p = 0.17 ) , and no significant differences were found . The incidence of asymptomatic bacteriuria in the intervention group was 5.8 % and in the control group was 14.5 % ( p = 0.01 ) . Conclusions No significant differences were found in the use of prophylactic antibiotic compared to placebo to reduce the incidence of UTI in patients who undergo cystoscopy as an outpatient procedure with sterile urine demonstrated by urine culture OBJECTIVES To investigate the incidence of symptomatic and asymptomatic bacteriuria and to assess patient satisfaction after flexible cystoscopy  ( FC ) and  urodynamic ( UD ) evaluation in a prospect i ve survey . The incidence of urinary tract infection after FC and UD studies and the use of prophylactic antibiotics are issues of debate . The tolerability and acceptance of FC and UD studies by patients have not been thoroughly documented . It would be helpful to be able to give such information to patients before performing these procedures . METHODS A total of 215 nonconsecutive patients seen as out patients for FC and UD studies to evaluate various indications were studied . A midstream urine sample was taken before and 48 hours after the procedures . Patients were given a question naire that inquired about the presence of lower urinary tract symptoms before and 48 hours after the procedures . The self-administered question naire included questions to assess patients ' tolerance of the procedures and how it compared with their expectations . RESULTS Of the 201 patients analyzed ( FC 103 , UD studies 98 ) , 9 patients ( 4 . 5 % ) developed significant bacteriuria within 48 hours of FC and UD studies . Only 2 patients with significant bacteriuria reported newly developed symptoms within 48 hours . In a subgroup of 25 patients who were given prophylactic antibiotics for various reasons , 6 ( 24 % ) reported new symptoms , although none developed significant bacteriuria . The association between patients who had preprocedure pyuria ( n = 7 ) and the development of significant growth after the procedure ( n = 6 ) was significant ( P < 0.01 ) . In response to the patient-satisfaction question naire , 166 ( 82.5 % ) reported that the procedure was not as bad as they expected , and 200 ( 99.5 % ) said that they would undergo the test again if necessary . CONCLUSIONS FC and UD studies are safe , well-tolerated procedures . The addition of prophylactic antibiotics in these procedures is unnecessary , unless specific indications are present The effect of prophylactic antibiotics on bacterial colonization of the respiratory tract and on general progression of  cystic fibrosis  was studied in a two-year prospect i ve study of 47 mildly to moderately affected patients . One group of patients received inhaled cephaloridine and the other received no inhaled antibiotic ; both groups received cloxacillin orally .  Carriage of Haemophilus influenzae was greater in the group not receiving inhaled antibiotic ( 55 % vs 20 % ) . Rates of carriage of Staphylococcus aureus ( 23 % ) . Pseudomonas aeruginosa ( greater than 90 % ) . Pseudomonas cepacia ( 45 % ) , and other organisms were similar in both groups . There were no significant differences between the two groups in incidence of respiratory tract infections or hospital admissions , clinical scores , radiologic scores , or rate of change of pulmonary function . Although continuous antistaphylococcal antibiotic prophylaxis may be successful in suppressing colonization with S. aureus , it may also contribute to the high rates of carriage of Ps . aeruginosa and Ps . cepacia observed in patients with cystic fibrosis OBJECTIVES One of the main drawbacks of flexible urethrocystoscopy is the risk of urinary tract infection ( UTI ) . In order to reduce this risk , antimicrobial prophylaxis has been considered , however there is not a unanimous view regarding indications , dosage , type of antibiotic , and so on . To clarify this uncertainty , we practice d a pilot and experimental study aim ed at assessing the effectiveness of chemoprophylaxis with 3 grams of fosfomycin trometamol in the prevention of UTI after urethrocystoscopy . METHODS Sixty patients were entered into a pilot r and omized clinical trial between March and August 2011 . Thirty patients were assigned to a control group without receiving any antibiotic dose , and the intervention group ( 30 patients ) received 3 g fosfomycin trometamol . Ten days later urine culture and sediment analysis were performed in all patients . Significant bacteriuria was considered from > 105 CFU /ml . One month later a telephone survey was developed to assess urinary symptoms , and assistance to the family doctor . We estimated the cumulative incidence of bacteriuria , pyuria and microhematuria in both groups , and we compared the results using a strategy of analysis per protocol and intention to treat . RESULTS The incidence of bacteriuria , pyuria and microhematuria in the control group was 10 % , 23.3 % and 26.7 % respectively and in the intervention groups the values differed depending on the type of analysis . Considering only the 27 patients ( per protocol analysis ) , the incidence would be 11.1 % , 37.0 % and 29.6 % respectively . If we include the three patients who did not completed the study ( per intention to treat analysis ) and considering their results as negative , the results were 10 % , 33.3 % and 26.7 % respectively . Finally , in the case the three cultures not performed in this group had produced a positive result , the impact would have been 20.0 % , 43.3 % and 36.7 % . In any of the three cases , the differences with the control group were not statistically significant . CONCLUSIONS In a selected population and with appropriate aseptic measures , antibiotic chemoprophylaxis does not appear to show a clinical ly relevant reduction in the incidence of UTI in patients undergoing flexible urethrocystoscopy OBJECTIVES To evaluate whether antistaphylococcal prophylaxis in infants and young children with cystic fibrosis ( CF ) would suppress the acquisition of Staphylococcus aureus and delay the onset of the manifestations of bronchopulmonary disease . STUDY DESIGN A 7-year , multicenter , double-blind , placebo-controlled study of continuous antistaphylococcal therapy .  Otherwise healthy children < 2 years of age with CF were r and omly assigned to be treated with daily cephalexin ( 80 - 100 mg/kg/day ) or placebo .  Clinical , microbiologic , laboratory , radiographic , and anthropometric outcomes were evaluated . RESULTS Of 209 children enrolled , 119 completed a 5- to 7-year course of therapy . Mean age at enrollment was 15.6 and 14.1 months in the cephalexin and placebo groups , respectively . Respiratory cultures from children treated with cephalexin were significantly less likely to be positive for S aureus ( 6.0 % vs 30.4 % ; P < .001 ) . They were , however , much more likely to be positive for Pseudomonas aeruginosa ( 25.6 % vs 13.5 % ; P < .009 ) . These differences became apparent in the first year after enrollment and persisted over the duration of the study . In contrast to these microbiologic differences , there were no differences in clinical outcome measures , including radiographic ( Brasfield score , 23.4 vs 23.2 ) or anthropometric scores or pulmonary function . CONCLUSIONS Although long-term prophylaxis with cephalexin successfully delayed the acquisition of S aureus , it enhanced colonization with P aeruginosa and did not lead to clinical ly significant improvement in major health outcomes . These data do not support routine antistaphylococcal prophylaxisin otherwise healthy infants and young children with CF Instrumentation of lower urinary tract is a predisposing factor for the development of  urinary infection .  Incidence of infective complications following urethrocystoscopy has been evaluated in a multicenter , prospect i ve , comparative and r and omized study in 2,284 patients , who had a previous negative urine culture . Patients were r and omized into two groups : one to be used as control and the other one to received antimicrobial prophylaxis prior to instrumentation ( ceftriazone , 1 gr intramuscular ) . Clinical and microbiological responses were evaluated at 48 - 72 hours and 4 weeks after cystoscopy . Symptomatic bacteriuria was observed in 10.2 % of patients in the control group and in 2.5 % in the prophylaxis group ( p < 0.000 ) ; asymptomatic bacteriuria in 3.02 % and 1.52 % ( p > 0.05 ) and irritative syndrome with sterile urine in 2.93 % and 2.60 % ( p > 0.05 ) , respectively . Thus , the use of prophylaxis reduced the incidence of infective complications in these patients The antimicrobial prescribing practice s of 26 physicians from the U.K. and Eire who care for patients with cystic fibrosis ( CF ) were assessed by postal question naire . Our main aim was to delineate divergent practice s which may reveal a need for controlled prospect i ve studies . For first-line intravenous ( i.v . ) therapy of acute exacerbations associated with Pseudomonas aeruginosa , 20 physicians ( 76.9 % ) combine a penicillin derivative with an aminoglycoside , in contrast to five ( 19.2 % ) who regularly use i.v . monotherapy with ceftazidime and one who combines i.v . ceftazidime with an aminoglycoside . When i.v . therapy is considered inappropriate , oral ciprofloxacin is sometimes used by all clinicians and oral broad spectrum agents are used in addition by 13 , chloramphenicol being prescribed most often . Excluding allergy , the most important factor influencing choice of agents by 19 ( 73.1 % ) physicians is the most recent sputum susceptibility results . For maintenance therapy , 21 prescribe oral anti-staphylococcal agents if Staphylococcus aureus is isolated ; of these , eight do so only if lung function deteriorates , nine after repeated isolation and four after first isolation of S. aureus . The remaining five physicians give anti-staphylococcal drugs to all patients once the diagnosis of CF is made . For maintenance of lung function in patients with persistent P. aeruginosa , all physicians used nebulized antibiotics , the indications for which vary between units . There was general concordance in the therapy of exacerbations associated with P. aeruginosa , whereas the use of agents to maintain lung function is more varied . We suggest that prospect i ve studies address practice s which vary greatly , such as the route , the duration and the timing of initiating antibiotic therapy given to maintain lung function BACKGROUND The benefit of antibiotic prophylaxis for intracranial pressure ( ICP ) monitors remains controversial , and clinical practice varies widely . Whether any antibiotic coverage , particularly broad-spectrum coverage , reduces monitor-related infections remains unproved , and exposure to antibiotics may affect the susceptibility patterns of pathogens producing subsequent infectious complications . Despite the lack of data supporting its use , our level I trauma center had a long-st and ing ICP monitor prophylaxis protocol that provided broad-spectrum coverage that included ceftriaxone . In April 2002 , a protocol change was instituted that substituted cefazolin for ceftriaxone as single-agent prophylaxis for ICP monitors . HYPOTHESIS Broader-spectrum antibiotic prophylaxis does not reduce ICP monitor-related infections but is associated with acquisition of more drug-resistant infections than narrow-spectrum prophylaxis . METHODS To evaluate the influence of broad- versus narrow-spectrum prophylaxis , a three year period encompassing each practice was selected . All injured patients with ICP monitors placed between January 1 , 2001 , and December 31 , 2003 ( n = 279 ) , were identified using the V and erbilt trauma data base . Antibiotic prophylaxis for ICP monitors was determined using the hospital financial data base to identify all antibiotics given to individual patients and subsequent chart review to identify those antibiotics given solely for ICP prophylaxis . A total of 119 patients received narrow-spectrum ( either cefazolin or vancomycin ; n = 100 ) or no ( n = 19 ) prophylaxis , whereas 160 received broad-spectrum prophylaxis ( ceftriaxone or ciprofloxacin ) . The two groups did not differ with respect to baseline demographics , type of ICP monitor , or duration of monitor placement . Infectious complications were determined by continuous infection surveillance utilizing st and ard U.S. Centers for Disease Control and Prevention National Nosocomial Infection Surveillance System ( CDC-NNIS ) definitions and maintained in a contemporary data base . The influence of broad-spectrum antibiotic prophylaxis on both ICP monitor infections and subsequent infections outside the central nervous system ( CNS ) was determined . RESULTS Nine patients ( 3.2 % ) developed CNS infections ; two of 119 patients ( 1.7 % ) who received narrow-spectrum or no prophylaxis versus seven of 160 patients ( 4.4 % ) who received broad-spectrum prophylaxis ( p = NS ) . Only the duration of monitor placement and Injury Severity Score were associated with the infection rate . In the total population , 185 infections occurred in 93 patients ( 33 % ) . Infection rates did not differ between patients who received narrow-spectrum or no prophylaxis ( 32 % ) and those who received broad-spectrum prophylaxis ( 34 % ) . However , patients who received broad-spectrum prophylaxis acquired gram-negative infections with significantly greater antibiotic resistance . CONCLUSIONS Broad-spectrum antibiotic prophylaxis of ICP monitors does not reduce CNS infections , but is associated with a shift to resistant gram-negative pathogens in subsequent infectious complications . Thus , broad-spectrum antibiotic prophylaxis of ICP monitors should be eliminated or minimized unless data from r and omized trials prove its utility INTRODUCTION It has been demonstrated previously that the identification of bactibilia during cholecystectomy is associated with the presence of one or more risk factors : acute cholecystitis , common duct stones , emergency surgery , intraoperative findings and age > 70 years . Current evidence -based guidance on antibiotic prophylaxis during  laparoscopic cholecystectomy ( LC ) is based on elective procedures and does not take into account these factors . The aim of this study was to assess the effectiveness of a selective antibiotic prophylaxis policy limited to high risk patients undergoing LC with the development of port site infections as the primary endpoint . METHODS One hundred consecutive patients undergoing LC under the care of a single consultant surgeon during a one-year period were studied prospect ively . Data collected included patient demographics ( age , sex ) as well as details of the history of gallstone disease to determine those with complex disease and risk factors for bactibilia . A single dose of antibiotics ( second generation cephalosporin and metronidazole ) was administered on induction to patients with a risk factor present . Information relating to all radiologically or microbiologically confirmed infections was documented . RESULTS Eighty-four of the patients were female and the mean age was 47.7 ±16.0 years . Nineteen LCs were performed as emergencies and the remainder were elective procedures . A risk factor for bactibilia was present in 35 patients . A wound infection was identified in four cases , two of which were Staphylococcus aureus ( one methicillin resistant ) , one was a coagulase negative Staphylococcus and one wound cultured a mixed anaerobic growth . Three of the infections occurred in patients receiving prophylaxis ( 2 staphylococcal and 1 anaerobic ) at intervals of 7 , 14 and 19 days respectively . One patient with a body mass index of 32kg/m² in the ' no prophylaxis ' group developed a coagulase negative staphylococcal infection at 10 days . No intra or extra-abdominal abdominal infections were identified . CONCLUSIONS This study has demonstrated that restricting antibiotic prophylaxis to high risk patients has no detrimental effects in terms of increasing the rate of infections in those with no risk factors . Furthermore , the act of not prescribing to low risk patients will limit costs and the risk of adverse events . It will also reduce the risk of resistance and clostridial infections in this cohort BACKGROUND Antimicrobial prophylaxis in cardiac surgery has been demonstrated to lower the incidence of surgical site infection ( SSI ) . Inappropriate antimicrobial prophylaxis , such as inappropriate selection of the antimicrobial agent or inappropriate dosing regimen , can increase the prevalence of antibiotic resistant strains , prolong hospital stay , cause adverse reactions , and negatively affect an institution 's pharmacy budget for antibiotics . In developing countries such as Jordan , where the role of clinical pharmacists is still in its primary stages , the first step in establishing an organized clinical pharmacy service is the evaluation of current practice to determine the need for improvement . OBJECTIVE To assess the degree of adherence to international guidelines for antimicrobial prophylaxis practice in cardiac surgery performed at Queen Alia Heart Institute ( QAHI ) in Amman , Jordan , as part of an attempt to determine opportunities for clinical pharmacist intervention . METHODS For a total of 236 patients who were admitted for cardiac surgery to QAHI - the only official referral hospital for cardiac patients in Jordan - between November 19 , 2006 , and January 22 , 2007 , the antimicrobial prophylaxis indication , choice , duration , dose , dosing interval , and timing appropriateness were assessed against 3 international guidelines using a pre-tested , structured clinical data collection form that was completed by 2 of the authors who work at QAHI . The study design was prospect i ve . All patients who were scheduled for surgery were monitored daily during their inpatient stay until discharge and then were tracked in the outpatient clinic for 2 months following surgery . Data regarding antimicrobial prophylaxis indication , choice , duration , dose , dosing interval , and timing appropriateness were collected during the patient 's inpatient stay ; data collection was performed periodically thereafter as data became available until the end of the 2-month follow-up . The 3 guidelines agreed that ( a ) antimicrobial prophylaxis should be given to all patients undergoing cardiac surgeries ; ( b ) the first- or second-generation cephalosporins ( cefazolin or cefuroxime ) are the antibiotics of choice , and vancomycin use is reserved for cases of allergy to beta-lactams or if presumed or known methicillin-resistant Staphylococcus aureus ( MRSA ) colonization is present ; ( c ) the timing of the first dose should be within 60 minutes prior to the skin incision ; and ( d ) the duration of antimicrobial prophylaxis should not be longer than 48 hours . RESULTS Adherence to all antimicrobial prophylaxis guidelines was not achieved for any study patients . For the 6 evaluated criteria , ( 1 ) indication : in 100 % of patients the appropriate decision was made to use antimicrobial prophylaxis in concordance with guidelines ; ( 2 ) choice : only 1.7 % of patients received the antibiotic of choice ; ( 3 ) duration : 39.4 % of patents received antimicrobial prophylaxis for a total duration of 48 hours or less in concordance with guidelines , and for 58.9 % of patients , duration was longer than recommended ; ( 4 ) dose : 27.9 % of patients received an appropriate dose ; ( 5 ) dosing interval : only 13.0 % of patients received an appropriate dosing interval , and none of the doses of antimicrobial prophylaxis used at induction of anesthesia was repeated in operations that lasted longer than the half-life of the antibiotic used ; and ( 6 ) timing : 99.1 % of patients received antimicrobial prophylaxis dose within 60 minutes prior to skin incision as recommended by guidelines , but 97.0 % of patients received an unnecessary midnight dose of intravenous antibiotic the night before surgery . CONCLUSION Study findings indicate that adherence to international guidelines for antimicrobial prophylaxis is far from optimal in QAHI , leading to the inappropriate administration of many antibiotics . Developing local hospital guidelines , as well as giving the clinical pharmacist a central role in the administration , monitoring , and intervention of antimicrobial prophylaxis may improve the current practice BACKGROUND --Pacemaker pocket infection is a potentially serious problem after permanent pacemaker implantation .  Antibiotic prophylaxis is commonly prescribed to reduce the incidence of this complication , but current trial evidence of its efficacy is conflicting . A large prospect i ve r and omised trial was therefore performed of antibiotic prophylaxis in permanent pacemaker implantation . The intention was firstly to determine whether antibiotic prophylaxis is efficacious in these patients and secondly to identify which patients are at the highest risk of infection . METHODS --A prospect i ve r and omised open trial of flucloxacillin ( clindamycin if the patient was allergic to penicillin ) v no antibiotic was performed in a cohort of patients undergoing first implantation of a permanent pacing system over a 17 month period .  Intravenous antibiotics were started at the time of implantation and continued for 48 hours . The trial endpoint was a repeat operation for an infective complication . RESULTS --473 patients were entered into a r and omised trial . 224 received antibiotic prophylaxis  and 249 received  no antibiotics . A further 183 patients were not r and omised but were treated according to the operator 's preference ( 64 antibiotics , 119 no antibiotics ) ; these patients are included only in the analysis of predictors of infection . Patients were followed up for a mean ( SD ) of 19(5 ) months . Among the patients in the r and omised group there were nine infections requiring a repeat operation , all in the group not receiving antibiotic ( P = 0.003 ) . In the total patient cohort there were 13 infections , all but one in the non-antibiotic group ( P = 0.006 ) . Nine of the infections presented as erosion of the pulse generator or electrode , three as septicaemia secondary to Staphylococcus aureus , and one as a pocket abscess secondary to Staphylococcus epidermidis . Infections were significantly more common when the operator was inexperienced ( < or = 100 previous patients ) , the operation was prolonged , or after a repeat operation for non-infective complications ( principally lead displacement ) . Infection was not significantly more common in patients identified preoperatively as being at high risk ( for example patients with diabetes mellitus , patients receiving long term steroid treatment ) , although there was a trend in this direction . CONCLUSIONS --Antibiotic prophylaxis significantly reduced the incidence of infective complications requiring a repeat operation after permanent pacemaker implantation . It is suggested that antibiotics should be used routinely BACKGROUND The purpose of this prospect i ve study was to determine the effectiveness of targeted interventions to improve compliance with  antibiotic prophylaxis guidelines ( timing , spectrum , and discontinuation ) at 2 university-affiliated hospitals . METHODS Based on barriers identified previously , hospital-specific interventions were developed such as educational conferences , st and ardized forms , an extended time-out , and feedback . Guideline compliance and surgical site infection ( SSI ) data were recorded on all patients who underwent elective laparotomies for colorectal procedures , vascular operations , and hysterectomies during four 6-month study periods . Pre study data from July to December 2006 served as a baseline . One year later , a prospect i ve cohort study was performed . The interventions were introduced to the 2 hospitals in a staggered fashion with 2-month implementation periods before reassessing compliance during the 6-month study periods . General linear modeling was performed ( P < .05 significant ) . RESULTS Compliance with all 3 guidelines combined improved during the year preceding the study , after attention only , at both hospitals . Hospital-specific differences were found in the effectiveness of the intervention package on individual guidelines . Hospital 2 but not 1 improved in timing after the interventions ; both hospitals improved in spectrum , and neither hospital improved in discontinuation . Overall compliance with all 3 antibiotic prophylactic measures was greater at hospital 1 , but hospital 2 had lower SSI rates . CONCLUSION Simply increasing attention to a quality problem can result in a significant and sustained improvement . Quality improvement interventions should be evaluated rigorously for effectiveness given hospital-specific differences in effectiveness and for correlation of guideline compliance with outcome BACKGROUND There has been a great deal of discussion regarding the necessity of the prophylactic use of antibiotics in transurethral procedures . In order to clarify this complicated issue , a r and omized prospect i ve study was performed for patients undergoing urethrocystoscopy or urethrocystography . PATIENTS AND METHODS Patients who underwent urethrocystoscopy or urethrocystography and did not have pyuria and bacteriuria were included and divided r and omly into 2 groups , either receiving a prophylactic antibiotic or no antibiotic . For antibiotic prophylaxis , 200 mg of sparfloxacin or fleroxacin were administered within a 1-hour period before the urethrocystoscopic or urethrocystographic examination , respectively . Analyses were performed on patients who were seen within 1 month after the examination , using the appearance of pyuria , bacteriuria , or a febrile infection as the endpoint . RESULTS Of 47 patients undergoing urethrocystoscopy , 45 were eligible for analysis , and of these , sparfloxacin was administered to 21 patients . Thirty-three of 37 patients undergoing urethrocystography were eligible for analysis with fleroxacin administered to 16 patients . There were no significant differences in the background factors between the 2 groups undergoing either transurethral examination . None of the patients in either group developed pyuria , bacteriuria or a febrile infection after the examination . CONCLUSIONS Prophylactic administration of antibiotics is not necessarily essential in urethrocystoscopy or urethrocystography in patients with sterile urine The aim of the present study was to obtain data on the outcome of children with persistent vesicoureteral reflux ( VUR ) after cessation of antibiotic prophylaxis . Children with VUR who had been on antibiotic prophylaxis for at least 2 y and were free of urinary tract infections ( UTI ) , had normal voiding patterns , and no hydronephrosis or new kidney scarring , had  antibiotic prophylaxis discontinued , were followed up prospect ively with  urine cultures , voiding cystourethrography , and technecium-99 m dimercaptosuccinate renal scintigraphy .  The findings were compared with those of the same patients while they were on antibiotic prophylaxis . In 54 children ( 39 girls and 15 boys ) , antibiotic prophylaxis was discontinued . The mean follow-up time on and off antibiotic prophylaxis was 4.4±2.1 and 4.4±2.2 y , respectively . Nine UTI episodes occurred during the on- and 8 during the off-prophylaxis period . In 80 of 96 and in 68 of 74 ureters the reflux resolved or down grade d during the on- and off-prophylaxis periods , respectively . No new scar lesions were detected in any of the children . In conclusion , in children with persistent VUR and certain characteristics , antibiotic prophylaxis can be safely discontinued
Conclusions : Antibiotic prophylaxis did confer a reduction in cases of symptomatic and asymptomatic bacteriuria but the NNT were high .
Introduction : The role of antibiotic prophylaxis for routine flexible cystoscopy ( FC ) is not clear due to the varying practice s of individual clinicians .
There are no formal guidelines , and this may be due to a lack of formal summary of the data .