Outpatient urological procedures in antibiotic-naive patients with bladder cancer with asymptomatic bacteriuria

Abstract

OBJECTIVES: • To investigate the frequency of infectious complications after intravesical BCG therapy or cystoscopy in antibioticnaive patients with bladder tumours who have asymptomatic bacteriuria. • The aim was to avoid antibiotics in infected patients undergoing these common outpatient urological procedures. METHODS: • A total of 354 patients received induction BCG therapy and another 663 patients underwent cystoscopy after submitting a voided urine sample for culture. They received no antibiotics before or after the procedure. • Significant bacteriuria was defined as > 104 or > 105 colony-forming units per millilitre with a single organism. • The patients were followed for 3 months for onset of febrile UTI, defined as dysuria and fever > 38 °C requiring antibiotics. RESULTS: • Ninety BCG-treated patients (25%) and 114 cystoscopy patients (17%) had bacteriuria. • After BCG therapy, two patients with infected urine (2.2%) and three with sterile cultures (1.1%) had febrile UTIs ( P = 0.17). • After cystoscopy, four infected patients (3.5%) and five uninfected patients (1%) had febrile UTIs ( P = 0.08). • All UTIs resolved within 24 h with oral antibiotics, and none of the patients was admitted for bacterial sepsis. CONCLUSIONS: • Antibacterial prophylaxis before intravesical BCG therapy or outpatient cystoscopy does not appear to be necessary in patients with asymptomatic bacteriuria. • Such strategy avoids overuse of antibiotics, reducing drug-resistant bacterial infections. © 2012 BJU International.