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<p>새 문서: Recommended Antimicrobial Prophylaxis for Urologic Procedures (AUA guidelines 2008) {| class=&quot;wikitable&quot; !Procedure !Organisms !Prophylaxis Indicated !Antimicrobial(s) of Choice !Alt...</p> <p><b>새 문서</b></p><div><br /> Recommended Antimicrobial Prophylaxis for Urologic Procedures (AUA guidelines 2008)<br /> {| class=&quot;wikitable&quot;<br /> !Procedure<br /> !Organisms<br /> !Prophylaxis Indicated<br /> !Antimicrobial(s) of Choice<br /> !Alternative Antimicrobial(s)<br /> !Duration of Therapy*<br /> |-<br /> | colspan=&quot;6&quot; |Lower Tract Instrumentation<br /> |-<br /> |Removal of external urinary catheter<br /> |GU tract† <br /> |If risk factors‡,§<br /> |<br /> * Fluoroquinolone<br /> * TMP-SMX<br /> |<br /> * Aminoglycoside (Aztreonam￥) ± Ampicillin<br /> * 1st/2nd gen. Cephalosporin<br /> * Amoxacillin/Clavulanate<br /> |≤24hours<br /> |-<br /> |Cystography, urodynamic study, or simple cystourethroscopy<br /> |GU tract<br /> |t If risk factors§<br /> |<br /> * Fluoroquinolone<br /> * TMP-SMX<br /> |<br /> * Aminoglycoside (Aztreonam￥) ± Ampicillin<br /> * 1st/2nd gen. Cephalosporin<br /> * Amoxacillin/ Clavulanate<br /> |≤24hours<br /> |-<br /> |Cystourethroscopy with manipulation <br /> |GU tract<br /> |All<br /> |<br /> * Fluoroquinolone<br /> * TMP-SMX<br /> |<br /> * Aminoglycoside (Aztreonam￥) ± Ampicillin<br /> * 1st/2nd gen. Cephalosporin<br /> * Amoxacillin/ Clavulanate<br /> |≤24hours<br /> |-<br /> |Prostate brachytherapy or cryotherapy<br /> |Skin<br /> |Uncertain<br /> |<br /> * 1st gen. Cephalosporin<br /> |<br /> * Clindamycin**<br /> |≤24hours<br /> |-<br /> |Transrectal prostate biopsy<br /> |Intestine†† <br /> |All<br /> |<br /> * Fluoroquinolone<br /> * 1st/2nd/3rd gen. Cephalosporin<br /> |<br /> * Aminoglycoside (Aztreonam￥)+ Metronidazole or Clindamycin**<br /> |≤24hours<br /> |-<br /> | colspan=&quot;6&quot; |'''Upper Tract Instrumentation'''<br /> |-<br /> |Shock-wave lithotripsy<br /> |GU tract <br /> |All<br /> |<br /> * Fluoroquinolone<br /> * TMP-SMX <br /> |<br /> * Aminoglycoside (Aztreonam￥) ± Ampicillin<br /> * 1st/2nd gen. Cephalosporin<br /> * Amoxacillin/ Clavulanate<br /> |≤24hours<br /> |-<br /> |Percutaneous renal surgery<br /> |GU tract and skin‡‡ <br /> |All <br /> |<br /> * 1st/2nd gen. Cephalosporin<br /> * Aminoglycoside (Aztreonam￥) + Metronidazole or Clindamycin<br /> |<br /> * Ampicillin/Sulbactam<br /> * Fluoroquinolone<br /> |≤24hours<br /> |-<br /> |Ureteroscopy<br /> |GU Tract<br /> |All<br /> |<br /> * Fluoroquinolone<br /> * TMP-SMX <br /> |<br /> * Aminoglycoside (Aztreonam￥) ± Ampicillin<br /> * 1st/2nd gen. Cephalosporin<br /> * Amoxacillin/Clavulanate<br /> |≤24hours<br /> |-<br /> | colspan=&quot;6&quot; |'''Open or Laparoscopic Surgery'''<br /> |-<br /> |Vaginal surgery (includes urethral sling procedures)<br /> |GU tract, skin and Grp B Strep<br /> |All<br /> |<br /> * 1st/2nd gen. Cephalosporin<br /> * Aminoglycoside (Aztreonam￥) + Metronidazole or Clindamycin<br /> |<br /> * Ampicillin/Sulbactam<br /> * Fluoroquinolone<br /> |≤24hours<br /> |-<br /> |Without entering urinary tract<br /> |Skin<br /> |If risk actors<br /> |<br /> * 1st gen. Cephalosporin<br /> |<br /> * Clindamycin<br /> |Single dose<br /> |-<br /> |Involving entry into urinary tract<br /> |GU tract and skin <br /> |All<br /> |<br /> * 1st/2nd gen. Cephalosporin<br /> * Aminoglycoside (Aztreonam￥) + Metronidazole or Clindamycin<br /> |<br /> * Ampicillin/Sulbactam<br /> * Fluoroquinolone<br /> |≤24hours<br /> |-<br /> |Involving intestine §§<br /> |GU tract, skin and intestine<br /> |All<br /> |<br /> * 2nd/3rd gen. Cephalosporin<br /> * Aminoglycoside (Aztreonam￥) + Metronidazole or Clindamycin<br /> |<br /> * Ampicillin/Sulbactam<br /> * Ticarcillin/Clavulanate<br /> * Pipercillin/Tazobactam<br /> * Fluoroquinolone<br /> |≤24hours<br /> |-<br /> |Involving implanted prosthesis<br /> |GU tract and skin<br /> |All<br /> |<br /> * Aminoglycoside (Aztreonam ￥)+1st/2nd gen. Cephalosporin or Vancomycin<br /> |<br /> * Ampicillin/Sulbactam<br /> * Ticarcillin/Clavulanate<br /> * Pipercillin/Tazobactam<br /> |≤24hours<br /> |}<br /> Order of agents in each column is not indicative of preference. The absence of an agent does not preclude its appropriate use depending on specific situations.<br /> {| class=&quot;wikitable&quot;<br /> |Key: gen, generation; Grp, group; GU, genitourinary; TMPSMX, trimethoprimsulfamethoxazole. * Additional antimicrobial therapy may be recommended at the time of removal of an externalized urinary catheter. † GU tract: Common urinary tract organisms are E. coli, Proteus sp., Klebsiella sp., Enterococcus. ‡ See “Patientrelated factors affecting host respo ¶nse to surgical infections.” If urine culture shows no growth prior to the procedure, antimicrobial prophylaxis is not necessary.<br /> |Or full course of culture-directed antimicrobials for documented infection (which is treatment, not prophylaxis). ￥Aztreonam can be substituted for aminoglycosides in patients with renal insufficiency. _ Includes transurethral resection of bladder tumor and prostate, and any biopsy, resection, fulguration, foreign body removal, urethral dilation or urethrotomy, or ureteral instrumentation including catheterization or stent placement/removal. **Clindamycin, or aminoglycoside+ metronidazole or clindamycin, are general alternatives to penicillins and cephalosporins in patients with penicillin allergy, even when not specifically listed.<br /> |†† Intestine: Common intestinal organisms are E. coli, Klebsiella sp., Enterobacter, Serratia sp., Proteus sp., Enterococcus, and Anaerobes. ‡‡ Skin: Common skin organisms are S. aureus, coagulase negative Staph. sp., Group A Strep. sp. For surgery involving the colon, bowel preparation with oral neomycin plus either erythromycin base or metronidazole can be added to or substituted for systemic agents. Copyright ⓒ 2008 American Urological Association Education and Research, Inc.Ⓡ Revised July 31, 2008<br /> |}</div>

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