Best of AUA 2014: Infection/Inflammation

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• Results from multiple studies point to the utility of obtaining rectal swab cultures prior to prostate biopsy to identify patients harboring fluoroquinolone-resistant bacteria and guide antibiotic prophylaxis. One study reported >10% of men were carriers of fluoroquinolone-resistant bacteria and that the post-biopsy sepsis rate decreased from 1.9% to 0.28% after implementation of pre-biopsy cultures, despite an increase in fluoroquinolone resistance.

• Compliance of U.S. urologists with AUA best practice guidelines for perioperative antibiotic prophylaxis in urologic surgery increased between 2007 and 2012, but 41% of urologists were still noncompliant, raising concern that some are adhering to older practice patterns that may provoke resistance.

• Bacteriology is the same in women with first-time and recurrent urinary tract infections, but the antibiotic susceptibility patterns of the two groups are strikingly different, indicating that urinalysis is essential to guide appropriate antibiotic therapy for women with recurrent UTIs.

• A decision and cost analysis for treatment of uncomplicated Escherichia coli cystitis using data from 18 Massachusetts hospitals determined nitrofurantoin (Macrobid, Macrodantin, Furadantin) was the most cost-effective agent for first-line treatment. Due to the potential for region/site-specific differences, such analyses need to be done using local antibiograms.

• A study of patients with neurogenic bladder and catheter-associated UTI found isolation of extended spectrum beta lactamase (ESBL) producing Escherichia coli increased over a 4-year period, particularly in nosocomial infections; the data raise concern about spread of ESBL resistance in hospitals and suggest a need for stringent screening protocols upon patient admission and potential isolation.

• Near-infrared spectroscopy to determine bladder tissue oxygen saturation is a promising method for rapid diagnosis of lower UTI.

• Isothermal calorimetry assessment of UTI isolates generates antibiotic susceptibility profiles within 7 hours, significantly decreasing the time from bacterial isolation to antibiotic therapy.

• An in vivo mouse model for interstitial cystitis/bladder pain syndrome will facilitate investigations of pathologic mechanisms of these disorders and therapeutic development.

• A prospective study with 5 years of follow-up suggests long-term cyclosporine A (Gengraf, Neoral, Sandimmune) is a promising treatment for refractory interstitial cystitis; outcomes showed significant improvements in symptom score, initial filling sensation, bladder capacity, and quality of life.UT

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