CUA Guidelines on antibiotic prophylaxis for urologic procedures

Guidelines are available for the use of antimicrobial prophylaxis in open operative procedures to prevent postoperative wound infections.1 However, the field of urology uses unique surgical approaches to treat various urologic conditions. Quite often, our approach does not require incisions; instead we use transluminal (endoscopy and catheter manipulation), transrectal (biopsy of the prostate) and/or completely non-invasive (extracorporeal shock wave lithotripsy [ESWL]) techniques. In urologic procedures, infections may arise not only from skin or rectal flora, but also from organisms in the vicinity of the operative site (i.e., struvite stones, subclinical prostatitis, pre-existing Foley catheters and stents). The sequelae of these infections can have devastating consequences, including significant morbidity and even death. The American Urological Association provides a Best Practice Policy Statement of Urologic Surgery Antimicrobial Prophylaxis.2 To provide a Canadian perspective, the Canadian Urological Association (CUA) Guidelines Committee approached our panel to provide rigorous evidence-based guidelines on the use of antimicrobial prophylactic therapy in urologic procedures that would be applicable in Canada. We concentrated our efforts on areas unique to urology, including urinary tract manipulation, stone surgery, endoscopic surgery and transrectal biopsy of the prostate (TURP). The evidence was then assessed and presented according to best standards of practice. Methods