A brand new study suggests that remedies are now being overused in upward to 60 per cent of patients undergoing common urological procedures. The study, directed by Daniel Livorsi, MARYLAND, University of Iowa associate professor of internal medication, shows that benefit rates of overuse were mainly due to extended use of antibiotics following a process. The findings were released Dec. 21 in JAMA Network Open.
Pretty for patients undergoing a urological or any other medical procedure to be given remedies as a precaution to prevent a surgery-related contamination. But overuse of remedies can promote antibiotic level of resistance, which the Centers for Disease Control and Avoidance has defined as a significant health concern. Moreover, unneeded use of antibiotics reveals patients to potential damage, such as an increased likelihood of infection by Chemical. difficile bacteria.
Based on evidence that the longer course of antibiotics will not add any benefit to patient outcomes and may in fact increase risks to patient health, the United states Urological Association (AUA) suggests that antibiotics should be provided for no more than 24 hours following most urological procedures.
Livorsi and his colleagues took two approaches to investigate whether urologists are following the AUA guidelines for antiseptic prescribing. They manually examined the medical records of 375 patients who experienced one of three common urological procedures. These methods all use endoscopic devices inserted into the harnröhre to examine and change portions of the urinary : tract. The patients were treated between January 2016 and July 2017 at five Veterans Health Administration hospitals located in various parts of the U. S.
The team also reviewed administrative data from 29, 530 patient records from the whole Veterans Health Administration system.
Overall, the study found that 217 of the 375 patients (58 percent) were recommended antibiotics in a way that did not follow the AUA guidelines. The most common deviation from the guidelines involved antibiotic-prescribing after the procedure: 211 patients (56 percent) were given antibiotics for longer than 24 hours following a procedure. In fact, patients were often given antibiotics for three to five days following a procedure rather than the 24 hours or less that the guidelines recommend.
The national administrative data also showed high rates of excess antibiotic prescribing; almost 40 % of records showed a median of three extra days of antibiotic therapy. Overall, there was good agreement between the results from the manual chart reviews and the administrative data among the cases evaluated by both data sources.
“This study shows that antibiotics are often continued for several days after common urologic procedures, even when there is no clear indication for antibiotics. This seemingly unnecessary use of antibiotics is exposing patients to potential harm, ” states Livorsi, who also is a physician with University of Iowa Health Care and the Iowa City VA Health Care System. “Reducing unnecessary antibiotic use in this setting is simply one example of how physicians can be better stewards of antibiotics. ”
The team chose to look at patients within the VA system because it is the biggest integrated health care system in the United States, which makes it simpler to do this type of study. However, Livorsi does not think the findings are unique to the VA. He notes other studies in non-VA settings have found similar results.
The study did not investigate why urologists are prescribing antibiotics for longer than recommended after a procedure. Given that the AUA provides clear suggestions for antibiotic treatment during these procedures, Livorsi believes it would be helpful to understand if urologists are not aware of the guidelines and the evidence at the rear of them, or when there are other reasons why urologists are certainly not adhering to the recommendations.
Nonetheless, the experts believe the research identifies the post-procedure period as a good possibility to improve antiseptic prescribing in a manner that could reduce antibiotic resistance and reduce health care costs damaging patient outcomes.
“If an individual undergoing surgery is given antibiotics for more than 24 hours, he or she should ask the provider to describe why more antibiotics are necessary, ” Livorsi says.
Materials provided by University of Iowa Wellness Care. Note: Content may be edited for style and length.