Introduction: There is a lack of consensus regarding the need to administer antibiotic prophylaxis (AP) at the time of catheter removal after urologic surgery. According to AUA guidelines, AP may be considered at the time of catheter removal. This guideline is based on low-quality evidence with a high risk of bias. The purpose of this study is to examine whether AP reduces symptomatic UTIs and hospitalizations after catheter removal. Methods: Patients undergoing elective urologic surgery were enrolled to this prospective trial and randomized 1:1 to treatment vs control groups. A single dose of P.O. AP was administered to patients in the treatment group 1 hour before catheter removal. The antibiotic of choice was cefuroxime axetil 500 mg. In case of known penicillin allergy or pre-operative urine culture with cefuroxime-resistant bacteria, trimethoprim/sulfamethoxazole 160/800 mg was used. Development of UTI and side effects were assessed through a telephone survey performed 30 days after catheter removal. Results: 211 patients were recruited and randomized: 106 and 105 to the treatment and control groups, respectively. No significant differences were found between groups regarding patients’ demographics, medical history, preoperative culture, operation type, and other parameters (see table). 101 patients in the treatment group and 96 patients in the control group were eligible for analysis. A statistically significant reduction was found in self-reported dysuria. Although no significant reduction was found in the overall readmission rate, a statistically significant reduction was found in the rate of readmissions due to febrile UTI (7.3% vs 1.0%, p=0.032). No differences were found in adverse effects between groups. Conclusions: AP at the time of catheter removal reduces the frequency of re-hospitalizations due to fever and UTI-related symptoms after urological operation. SOURCE OF Funding: self funding
