A Quality Improvement Initiative Improved Antibiotic Stewardship for Patients Undergoing Bladder Outlet Surgery

Purpose Patients undergoing bladder outlet surgery often have an indwelling catheter, are on clean intermittent catheterization, and/or have asymptomatic bacteriuria. Infectious disease guidelines recommend perioperative prophylaxis only, to limit antibiotic overuse without increasing infectious risk. Prior work at our institution has shown inappropriate extended use of prophylactic antibiotics for these patients. We evaluated the effectiveness of a quality improvement (QI) intervention to improve antibiotic stewardship for these patients. Methods A single-institution retrospective review of patients undergoing TURP, Greenlight PVP, or ThuLEP from 2020–2023 was done. The QI intervention, implemented June 6, 2022, included education on guideline-consistent perioperative antibiotic prophylaxis with ongoing reminders. Data collected included catheterization status, preoperative urine cultures, antibiotic prescriptions, and 30-day infection-related re-presentations. Appropriate preoperative antibiotic use was assessed using McNemar’s test. Results A total of 352 procedures were performed in 324 patients: TURP (54.3%), Greenlight PVP (24.1%), and ThuLEP (21.6%). Of these, 226 occurred pre-QI and 126 post-QI, with no difference in catheterization rates (34.5% vs 43.5%, p > 0.05). Pre-QI, antibiotic use exceeded culture positivity (33.1% vs 28.8%, p = 0.013), with 17.7% prescribed inappropriately. Post-QI, antibiotic use aligned with culture positivity (34% vs 33.3%, p = 1.0), and inappropriate prescribing decreased to 3.1%. Postoperative readmission rates were similar (2.2% vs 2.3%, p > 0.05). Conclusions A simple QI intervention reduced inappropriate and extended antibiotic prophylaxis for patients undergoing bladder outlet surgery, including those with increased clinical risks of infection. Identifying areas for practice improvement and straightforward, systematic interventions can improve the quality of care, in this case by improving antibiotic stewardship.