Original Article Is short course of antimicrobial therapy for asymptomatic bacteriuria before urologic surgical procedures sufficient? Selda Sayin Kutlu 1 , Zafer Aybek 2 , Koray Tekin 3 , Demet Okke 1 , Serife Akalin 1 , Serkan Altintas 2 , Melek Demir 4 Departments of Infectious Diseases and Clinical Microbiology 1 , Urology 2 , General Surgery 3 , and Microbiology and Clinical Microbiology 4 , Pamukkale University, Denizli, Turkey Abstract Introduction: Duration of treatment of asymptomatic bacteriuria for patients undergoing urologic surgical procedures is undetermined. We compared the efficacy of long- versus short-course antimicrobial treatment in patients with asymptomatic bacteriuria undergoing urologic surgical procedures. Methodology: Patients were divided into two groups according to duration of antimicrobial treatment. Group A patients received a single dose of an appropriate antibiotic, determined by antimicrobial sensitivity testing, 30 to 60 minutes before the surgical procedure. If a urinary catheter was placed postoperatively, a second dose was given following the recommended dose interval. Group B patients received antimicrobial treatment prior to surgery at least until patient urine became sterile. All patients were monitored for signs and symptoms of septicemia following surgical procedures. Results: None of the patients enrolled in the study developed infectious complications such as sepsis or upper urinary tract infection. In group A, 31 patients were treated with antimicrobials before 39 urological procedures. In group B, the mean treatment time for 28 patients before 30 urological procedures was 8.03 ± 3.86 days. There were also significant differences in length of stay and the cost of antimicrobial therapy between the groups (P < 0.0001). Isolation of an increased number of resistant microorganisms was associated with long course therapy in group B. Conclusions: Short course therapy protocol may be a practical, simple approach for antibiotic use; it decreases hospital stays, eliminates delayed procedure times, lowers the economic cost of antimicrobials and lessens the chance of superinfection with and spread of antimicrobial resistant microorganisms. Key words: antimicrobial; bacteriuria; urologic surgical procedures J Infect Dev Ctries 2012; 6(2):143-147. (Received 15 December 2010 – Accepted 27 April 2011) Copyright © 2012 Sayin Kutlu et al. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction Asymptomatic bacteriuria or asymptomatic urinary tract infections are common problems in particular groups such as catheterized patients while the catheter remains in situ, diabetic women, the elderly, and pregnant women [1]. Screening and treatment of asymptomatic bacteriuria in pregnant women and before some urological procedures has been recommended in the guidelines of the Infectious Diseases Society of America (IDSA) [2]. Preoperative bacteriuria was shown to increase the severe infectious complications such as bacteremia, septicemia, and upper urinary tract infection, especially following various urological interventions [3-6]. Accordingly, many studies have shown that appropriate antimicrobial treatment preoperatively and postoperatively could decrease the occurrence of these severe infectious complications [5,7,8]. However, the time interval that should be adhered to between antimicrobial therapy and the start of the surgical procedure as well as the length of the postoperative treatment is not clearly defined [1]. Long-term pre-treatment not only delays the operation, it may result in antibacterial resistance; however, a short course of antibiotic pre-treatment may not be sufficient to prevent postoperative bacteraemia [9]. The aim of the present study was to compare the effect of long-term versus short-course antimicrobial treatment in patients with asymptomatic bacteriuria undergoing specific urologic surgical procedures.