Recent Antibiotic Treatment Increases the Risk of Urinary Tract Infection after Outpatient Cystoscopy

Introduction: Symptomatic urinary tract infection is a complication of office based cystoscopy. AUA guidelines recommend prophylactic antibiotics for patients with an increased risk of urinary tract infection. However, study results are mixed regarding the efficacy of prophylaxis for urinary tract infection prevention. We evaluate predictors of infection to identify groups at increased risk for urinary tract infection after cystoscopy. Methods: We identified all office cystoscopies performed at a single institution from April 2012 through May 2014. Patients with a positive urine culture within 30 days of the procedure were reviewed for symptomatic urinary tract infection. Those with a urinary tract infection were matched to 4 controls. Patient characteristics were extracted and examined for association with urinary tract infection. A multivariable logistic regression model was fit to identify associations between composite clinical variables and urinary tract infection. Results: During the study period 5,488 patients underwent cystoscopy, of whom 29 (0.53%) had a urinary tract infection. Cultures showed quinolone resistant organisms in 13 of 29 (45%) urinary tract infections. The use of an external catheter or intermittent catheterization (p=0.04), hospitalization within 4 weeks (p=0.04) and the use of antibiotics within 6 months of cystoscopy (p=0.01) were associated with urinary tract infection. Recent antibiotic exposure, recent nongenitourinary infection or recent hospitalization was associated with urinary tract infection on multivariable analysis (OR 5.26, 95% CI 1.87-14.8, p <0.01). Conclusions: Recent antibiotic exposure, infection or hospitalization is associated with an increased risk of urinary tract infection after cystoscopy. Most symptomatic urinary tract infections are due to quinolone resistant organisms in this population. The optimal prophylactic regimen should be tailored to regional antibiotic susceptibility patterns and individual patient risk factors.