Only 1.9% of tumor patients who did not have prophylactic antibiotics developed febrile urinary tract infections after flexible cystoscopy, according to research published in the April issue of European Urology.
Even when patients presented with asymptomatic bacteriuria, less than 5% developed UTIs after cystoscopy, said Dr. Harry W. Herr, a urologist at Memorial Sloan-Kettering Cancer Center in New York.
When UTIs occurred, they resolved within 24 hours of starting oral antibiotic therapy and did not involve bacterial sepsis, he reported (Eur. Urol. 2014;65:839-42).
"These data strengthen European guidelines on urologic infections, which state that antibiotic prophylaxis is not recommended before cystoscopy in standard cases," said Dr. Herr. "However, the data also justify avoiding antibiotics in bacteriuric patients."
The prospective registry study enrolled consecutive outpatients with bladder cancer. Patients submitted voided urine samples for culture prior to undergoing flexible cystoscopy, and received no antibiotics before or immediately after. Dr. Herr defined significant bacteriuria as a single-organism culture of greater than 104 colony-forming units per milliliter, and febrile UTI as dysuria and temperature greater than 38° C, or receiving antibiotics from an outside physician for urinary tract symptoms.
Among the 2,010 patients, 489 (24%) had asymptomatic bacteriuria, while 1,521 (76%) had sterile urine, Dr. Herr reported. Thirty-nine patients (1.9%) developed febrile UTI within 30 days of cystoscopy, including 1.1% of noncolonized patients and 4.5% of colonized patients (P = .02).
Cystoscopy is common, and bladder cancer patients have variable risk factors for UTI, so "urologists may need to accept a 4.5% risk of symptomatic UTI to practice antibiotic stewardship by avoiding the overuse (misuse) of unnecessary antibiotics," wrote Dr. Herr.
He relied on patients to self-report UTI and related factors after their first week of follow-up, but he said that this limitation probably did not lead to underdetection of UTIs because most infections develop within several days of cystoscopy.
"It is the responsibility of all physicians to practice antibiotic stewardship and to avoid the unnecessary use of antibiotics where justified," Dr. Herr added. "The current robust data should persuade urologists to do their part."
The study received no funding support, and Dr. Herr reported that he had no conflicts of interest.