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Current Bladder Dysfunction Reports

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01-12-2020 | Aztreonam | Reconstructed Bladder Function & Dysfunction (M Kaufman, Section Editor)

Antibiotic Prophylaxis in Pelvic Floor Surgery

Authors: Gregory M. Kunkel, Joshua A. Cohn

Published in: Current Bladder Dysfunction Reports | Issue 4/2020

Abstract

Purpose of Review

The goal of this review is to summarize the current recommendations and evidence for the use of antibiotic prophylaxis in pelvic floor surgery. We provide a historical perspective on antimicrobial prophylaxis, review bacteria associated with pelvic floor surgery by site, and current antimicrobial prophylaxis recommendations from the American Urological Association (AUA) and American College of Obstetrics and Gynecology (ACOG).

Recent Findings

ACOG published updated recommendations for perioperative prophylaxis in June 2018 and the AUA in June 2019. There has been a complete de-emphasis on the use of fluoroquinolones; the preferred antimicrobials, when indicated, are first and second generation Cephalosporins alone for nearly all pelvic floor procedures via a vaginal or abdominal approach. Aside from allergy considerations, exceptions include reconstruction with use of large bowel, for which additional anaerobic coverage and mechanical and antibiotic bowel prep is recommended, and for select diagnostic and therapeutic procedures of the lower urinary tract, for which trimethoprim-sulfamethoxazole is recommended.

Summary

Pelvic floor surgery is unique due to its variable surgical approaches and the range of potential infectious sources to be considered (i.e., the skin, vagina, bladder, intestine). Urinary tract infection is the most common infectious complication across nearly all procedures, although its prevention is not simply related to antibiotic selection and duration. Antibiotic stewardship calls for judicious use, including non-use when risks are low. Although updated societal guidelines provide the foundation on which most perioperative antimicrobial recommendations should be based, surgeons must consider patient-specific factors (e.g., multidrug -resistant bacteriuria) and local antibiograms. Input from colleagues in pharmacy and infectious diseases may optimize antibiotic selection, dosing, and duration, particularly when non-guideline antibiosis appears to be indicated.

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Title: Antibiotic Prophylaxis in Pelvic Floor Surgery
Authors: Gregory M. Kunkel
Joshua A. Cohn
Publication date: 01-12-2020
Publisher: Springer US
Keywords: Aztreonam
Ampicillin
Metronidazole
Gentamicin
Aminoglycoside
Antibiotic
Clindamycin
Urinary Tract Infection
Cefazolin
Vaginal Surgery
Cephalosporin Antibiotic
Published in: Current Bladder Dysfunction Reports / Issue 4/2020
Print ISSN: 1931-7212
Electronic ISSN: 1931-7220
DOI: https://doi.org/10.1007/s11884-020-00601-4

At a glance: The STEP trials

Springer Medicine

Antibiotic Prophylaxis in Pelvic Floor Surgery

Abstract

Purpose of Review

Recent Findings

Summary

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

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