Controversies in antimicrobial prophylaxis for urologic surgery: more up-to-date evidence is needed

Abstract

The American Urological Association has published guidelines for the use of antimicrobial prophylaxis in the prevention of surgical site infection. The guidelines recommend that antimicrobial prophylaxis is required for most urologic operations, including transurethral endoscopic, open and laparoscopic procedures. By contrast, the guidelines published by the European Association of Urology recommend that no procedures require antimicrobial prophylaxis, except surgery that involves the use of bowel segments. The main reason for these differences is that both guidelines are largely based on data from general surgery, because few well-controlled, randomized studies of urologic surgery have been reported. Controversies have arisen because of differing views regarding the applicability of evidence from general to urologic surgery. Particularly controversial are the guidelines for clean-contaminated procedures, such as entering the urinary tract and using bowel segments. This commentary discusses the practical application of these new guidelines by considering previously published recommendations.