Antibiotic prophylaxis in ambulatory cystoscopy: Challenging its role even in high-risk patients-prospective observational study.

Abstract

Purpose: Cystoscopy is a commonly performed outpatient urological procedure, with post-procedural urinary tract infections (UTIs) being a key concern. It is generally safe, but high-risk individuals (e.g., diabetics, chronic obstructive pulmonary disease [COPD], immunodeficiency) have a higher risk for potential UTIs. This study evaluates the effectiveness of antibiotic prophylaxis in preventing post-cystoscopy UTIs.

Materials and methods: A prospective observational study was conducted in 2023, enrolling 300 adult patients undergoing ambulatory flexible cystoscopy who were divided into two cohorts: cystoscopy with and without antibiotic prophylaxis. The primary outcome was UTI incidence within four weeks post-procedure, defined by a positive urine culture (>10⁵ CFU/mL) and accompanying symptoms, antibiotic prescriptions, or emergency visits. Positive urine cultures confirmed the primary outcomes.

Results: The study involved 300 patients: 150 received antibiotic prophylaxis (Cohort A), and 150 did not (Cohort B), showing no significant differences in clinical and demographic variables. UTI incidence was 9.3% in Cohort A and 10.0% in Cohort B, with no statistically significant difference (p=0.510). No cases of urinary sepsis were observed. Risk factors such as diabetes, ischemic heart disease, and COPD were evenly distributed across both cohorts.

Conclusions: Antibiotic prophylaxis did not significantly reduce post-cystoscopy UTI rates. These findings suggest that routine prophylactic antibiotic use may be unnecessary in low-risk patients, reinforcing the need for antibiotic stewardship. Further large-scale studies are warranted to refine clinical guidelines.