ArticleJAC-antimicrobial resistance2026
Embedding locally tailored antimicrobial prophylaxis into standardized order sets for urological procedures reduces antimicrobial use.
Article in JAC-antimicrobial resistance, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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4 authors.
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Abstract
Introduction: Inappropriate selection and dosing of antimicrobial prophylaxis (AP) for urological procedures remain common. We therefore evaluated the impact of a locally adapted AP guideline, embedded within standardized pre-procedure order sets and supported by antimicrobial stewardship interventions, on antimicrobial utilization in a high-resistance setting. Methods: A 1-year study of the three phases-pre-intervention, intervention and after intervention-was performed at a tertiary care hospital in Thailand. The intervention included development of local AP guidelines based on the institutional antibiogram, integration into one-page order sets, multifaceted education and feedback. Antimicrobial utilization was assessed using days of therapy (DOT) per 1000 patient-days. Interrupted time series (ITS) analysis was used to evaluate changes in antimicrobial use over time. Postoperative urinary tract infections (UTIs) and surgical site infections (SSIs) within 30 days were monitored. Results: A total of 657 urological procedures were included. Median total DOT per admission declined from 10 days (IQR 8-12) to 2 days (IQR 1-4) ( Conclusions: Implementation of locally tailored AP guidelines integrated into standardized order sets, supported by stewardship interventions, was associated with a substantial and sustained reduction in antimicrobial exposure for urological procedures. This approach is relevant to high-resistance, resource-limited settings.
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