Patients undergoing bladder outlet surgery often face the challenge of managing indwelling catheters, clean intermittent catheterization, and asymptomatic bacteriuria, which can lead to inappropriate antibiotic use. Infectious disease guidelines recommend limiting prophylactic antibiotics to the perioperative period to prevent overexposure without increasing the risk of infection. This study aimed to evaluate the effectiveness of a quality improvement (QI) initiative designed to enhance antibiotic stewardship for patients undergoing procedures such as TURP, Greenlight PVP, and ThuLEP at our institution between 2020 and 2023.
The intervention, implemented on June 6, 2022, involved educating staff about the rationale for administering only perioperative prophylaxis, along with ongoing reminders through conferences and emails. A retrospective review identified 324 patients (median age 71 years) who underwent a total of 352 bladder outlet surgeries. Prior to the QI initiative, 17.7% of antibiotic prescriptions were deemed inappropriate, with 33.1% of patients receiving antibiotics despite negative urine cultures. After the QI intervention, only 3.1% of prescriptions were inappropriate, and no significant difference was noted in preoperative antibiotic use compared to positive urine culture rates (34% vs. 33.3%, p=1.0). The postoperative readmission rate remained low and similar across both time periods (2.2% vs. 2.3%, p>0.05).
The findings suggest that a focused QI initiative can significantly reduce unnecessary and extended antibiotic prophylaxis in patients undergoing bladder outlet surgery, ultimately improving the quality of care through better antibiotic stewardship.
