Transition from extended to single-dose antibiotic prophylaxis was not associated with increased postoperative infectious complications in urologic surgery

Extended perioperative antibiotic prophylaxis (PAP) remains common in urologic surgery despite guideline recommendations supporting single-dose PAP. This study aimed to evaluate the impact of transitioning from extended PAP to single-dose PAP on postoperative infectious complications (PICs) in patients undergoing urologic procedures. This single-center cohort study included patients undergoing urologic surgery during two consecutive one-year periods before and after a protocol change from extended PAP to single-dose PAP. Demographic, clinical, and perioperative variables were recorded. PICs were defined as surgical site infections (SSIs), urinary tract infections (UTIs), or sepsis according to CDC and AUA criteria. Multivariable logistic regression analysis was performed to identify independent predictors of PICs. A total of 2,057 patients were included, with 966 in the extended PAP group and 1,091 in the single-dose PAP group. Overall, PICs occurred in 41 patients (2.0%). The incidence of PICs was lower in the single-dose PAP group compared with the extended PAP group (1.4% vs. 2.7%, p = 0.048); however, the prophylaxis protocol was not independently associated with PICs in multivariable analysis ( p = 0.111). In the parsimonious adjusted analysis, the prophylaxis protocol was not significantly associated with PICs (OR 0.523, 95% CI 0.264–1.038, p = 0.064). Diabetes mellitus, non-endoscopic surgery, sterile pyuria, and a prolonged culture–surgery interval (> 21 days) were associated with an increased risk of PICs. Implementation of Single-dose PAP was not associated with an increased risk of PICs compared with the previous extended PAP. Several patient and procedure-related factors were associated with PICs. These findings are consistent with current guideline recommendations supporting single-dose PAP and highlight the importance of preoperative assessment of infection risk in urologic surgery.