Antimicrobial Selection for Transurethral Procedures Across the United States: A State-by-State Antibiogram Evaluation

Urology. 2022 Jan;159:107-113. doi: 10.1016/j.urology.2021.10.009. Epub 2021 Oct 27.


Objective: To evaluate optimal regimens for perioperative antimicrobial prophylaxis in transurethral procedures by examining antimicrobial susceptibility patterns in the United States.

Materials and methods: Through several methods, we attempted to attain an antibiogram for each state. We focused on microbes known to cause infections after transurethral surgeries and antibiotics referred to in current or prior recommendations and compared susceptibility rates across states using Kruskal Walis tests and the Dwass, Steel, Critchlow-Fligner tests. We also examined susceptibility to (non-ceftazidime) third generation cephalosporins.

Results: Data is included from 40 states. For each microbe studied, there was significant variability in sensitivity to antibiotics studied. Current first line recommendations for antimicrobial prophylaxis include first generation cephalosporins with 82%, 80%, and 87% mean coverage for E coli, Proteus, and Klebsiella respectively and trimethoprim-sulfamethoxazole with 74%, 80%, and 93% coverage, respectively. Susceptibility to aminoglycosides is 91%, 92%, and 96%, respectively and to third generation cephalosporin, it is 92%, 99%, and 94%.

Conclusion: Current first line recommended antimicrobials for prophylaxis in transurethral procedures provide overall poor predicted coverage based on our database of antibiograms. Alternatives exist that have higher predicted susceptibility, though clinical significance of this and risk of resultant antimicrobial resistance is unknown. Urologists should consider local patterns when selecting antimicrobial prophylaxis for their patients.

MeSH terms

  • Anti-Bacterial Agents* / adverse effects
  • Anti-Bacterial Agents* / classification
  • Anti-Bacterial Agents* / therapeutic use
  • Antibiotic Prophylaxis / methods*
  • Bacteria* / classification
  • Bacteria* / drug effects
  • Bacteria* / isolation & purification
  • Drug Resistance, Bacterial / drug effects
  • Humans
  • Microbial Sensitivity Tests* / methods
  • Microbial Sensitivity Tests* / statistics & numerical data
  • Postoperative Complications* / epidemiology
  • Postoperative Complications* / etiology
  • Postoperative Complications* / microbiology
  • Postoperative Complications* / prevention & control
  • Risk Factors
  • United States / epidemiology
  • Urethra* / microbiology
  • Urethra* / surgery
  • Urinary Tract Infections* / epidemiology
  • Urinary Tract Infections* / etiology
  • Urinary Tract Infections* / microbiology
  • Urinary Tract Infections* / prevention & control
  • Urologic Surgical Procedures* / adverse effects
  • Urologic Surgical Procedures* / methods


  • Anti-Bacterial Agents