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Is A Single Dose Of Pre-Procedure Antibiotic Safe and Cost-Effective In Spinal Cord Injury Patients With Colonized Urine Prior To Elective Endoscopic Procedures?
Jeffrey C Lou1, Tristan T Berry1, Camilo Castillo*2, Vidal M Despradel1, B Mayer Grob1, Adam P Klausner1
1VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEMS, RICHMOND, VA;2Hunter Holmes McGuire VA Medical Center, RICHMOND, VA
Introduction: Elective endoscopic procedures are frequently required in spinal cord injury (SCI) patients with colonized urine. It has been our practice to admit patients for 3 to 5 days of intravenous antibiotics and perform procedures after documentation of sterile urine. The goal of this investigation was to determine the safety and efficacy of a new protocol in which SCI patients are treated with a single dose of antibiotic prior to urologic procedures.
Methods: After IRB approval, a prospective trial was initiated. SCI patients with colonized urine scheduled for endoscopic procedures were randomized to 2 groups. Group 1 received 3-5 days of IV antibiotics, group 2 received a single dose 30 minutes prior to procedures. Patient demographics, vital signs, white blood cell counts, and infections were compared. Patients completed a validated quality of life health survey (EQ-5D) pre and post-operatively. Student t tests were used for statistical analysis.
Results: Thirty-eight procedures were performed on 36 patients. Mean age was 58 in group 1 (N=14) and 52 in group 2 (N=24). There were no infections in either group. The EQ-5D survey showed a decline in overall health in Group 1 (7.4 pre-procedure vs. 7.1 post-procedure, p = 0.019), but no difference in Group 2 (8.3 vs. 8.0, p = 0.20).
Conclusions: These results suggest that sterile urine may not be required in SCI patients prior to elective endoscopic procedures. A minimum cost-savings of $3357 per patient and a potential improvement in quality of life would be achieved using a shorter treatment protocol.
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