Prospective observational comparative study on antibiotic prophylaxis in cystoscopy: towards a rational use of antimicrobials

INTRODUCTION: Antibiotic resistance represents a major public health problem driven by inappropriate antimicrobial use. Cystoscopy is a common urological procedure associated with a low risk of urinary tract infection (UTI), and the role of routine antibiotic prophylaxis remains controversial. OBJECTIVE: To evaluate the effectiveness of antibiotic prophylaxis in preventing post-cystoscopy UTI. MATERIALS AND METHODS: A prospective observational comparative study including 297 patients undergoing outpatient cystoscopy. Patients were assigned to Group A (no prophylaxis, n=161) and Group B (cefuroxime 500 mg prophylaxis, n=136). Urine cultures were obtained one hour before and one week after cystoscopy. Significant bacteriuria was defined as >104 CFU/ml. Risk factors were analyzed according to current literature. Fisher's exact test and multivariate logistic regression were performed. Statistical analysis was performed using SPSS/R. RESULTS: UTI occurred in 5.59% of patients without prophylaxis and 5.88% with prophylaxis (p=1.00). Antibiotic prophylaxis did not reduce infection risk (OR 0.95; 95% CI 0.36-2.53). Baseline characteristics and risk factors were similar between groups. No independent predictor reached statistical significance. CONCLUSIONS: Routine antibiotic prophylaxis does not reduce post-cystoscopy UTI incidence in low-risk patients, supporting restrictive and rational antimicrobial use.