Incidence of urinary tract infections following flexible cystoscopy . A prospective study.

1. Omer Baldo, Hassan Khan, Philip Koenig, Nick Shaikh Department of Urology Airedale General Hospital. Incidence of urinary tract infections following flexible cystoscopy. A prospective study.

2. Background • Increasing incidence of global antimicrobial resistance • Urology as a speciality by its nature uses antibiotics with some liberty • The annual European Antibiotic Awareness Day (EAAD) campaign in England this year will highlight the need to 'Start Smart-Then Focus • The aim is that patients receiving antibiotics should receive the right drug at the right time at the right dose for the right duration

3. Introduction • Flexible cystoscopy is the commonest intervention performed by Urologists • Local issue with high rate of pseudomonas UTI • On going debate about the use of antibiotics prior to cystoscopy¹ 1. Neal D et al BJUI 2007 Oct;100 (4) 826-9

4. Patients and Methods • Prospective audit at single Unit • Over 26 months – Jan. 2009 to Mar. 2011 • In collaboration with Microbiology unit • 2 urine samples collected • Immediately pre procedure • 3 days post procedure

5. Results – 1 • 1089 patients included • Mean age 67.9yrs (± 16) • Total samples collected 1811 • 367 post cystoscopy samples NOT submitted

6. Results – 2 • Overall rate of UTI 8.5 % • Rate of UTI pre cystoscopy 6.2% • Incidence of UTI excluding missing samples 10.2%

7. Rate of UTI in all groups

8. Uropathogens Isolated

9. Published Data Authors Journal No. Rate of UTI • Neal et al BJUI 2007 2481 9% • Burke et al BJUI 2002 420 2.7% • Almallah et al Urology 2000 215 4.5% • Clark et al BJUI 1990 164 7.5%

10. Conclusion • UTI rate post outpatient cystoscopy is low • Prophylactic antibiotics are unnecessary • Prophylactic antibiotics should be used if approriate • Beware of the margarine container!!

11. Thank You • All our patients • Dr Paul Godwin – Consultant Microbiologist • All day case staff