Do antimicrobials have a role in preventing septicaemia following instrumentation of the urinary tract?

Urinary tract instrumentation is a significant cause of septicaemia. Review of the literature suggests that selective use of antimicrobials would redu ce the risk of septicaemia as this varies between patients and with procedu res. Antimicrobial prophylaxis is indicated for patients at high risk of en docarditis, or who are neutropenic. For patients without these risk factors , it is indicated for open, transurethral, or certain forms of laser prosta tectomy or trans-rectal prostate biopsy. For cystoscopy, antimicrobials are indicated for patients with preoperative bacteriuria or a preoperative ind welling catheter. Single dose aminoglycosides or oral fluoroquinolones are the agents of choice with the exception of the prevention of endocarditis, where combinations active against streptococci are recommended. For other i nstrumentations, the risk of antimicrobial toxicity probably outweighs the benefits and a risk-reduction strategy is recommended. Further studies are required to provide definitive answers in many of these areas. (C) 2000 The Hospital Infection Society.