The risk factors for post-procedural infection in the AUA (American Urological Association) Best Practice Statement are not based on high-level evidence.1 The authors assessed the impact of these risk factors on postcystoscopy urinary tract infection (UTI) with and without antimicrobial prophylaxis (AP) using a large observational cohort. Although not a randomized, controlled trial, the work provides useful insight. That the use of AP in patients with and without comorbidities (Table 2 in article) is equivalent provides reassurance as to the accuracy of the findings within the limitations of the study. AP was associated with a reduction of the incidence of clinical UTI after cystoscopy by 50. This suggests adequacy of the data to determine a difference of the same magnitude owing to risk factors. However, risk factors with a lower impact might have been insufficiently evaluated, and moreover the study did not include some potentially important risk factors such as recent antimicrobial use, prior UTI or ongoing catheterization. This finding that AP reduces the incidence of postcystoscopy UTI by 50 is noteworthy, but equally important is the conclusion that the number needed to treat with antimicrobial prophylaxis to prevent 1 infection after cystoscopy was 100. However, the incidence of UTI after cystoscopy was less than 1, likely because symptomatic UTIs diagnosed outside the authors’ institution are not in the data set.
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