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Perioperative Antibiotic Prophylaxis

Category: Pharmacology > Infection & Prophylaxis Last reviewed: April 2026

Overview​

Perioperative antibiotic prophylaxis aims to reduce surgical site infection (SSI) by achieving adequate tissue and urinary antibiotic concentrations at the time of incision. The foundational guidance for urologic prophylaxis is the AUA Best Practice Statement (BPS) 2020 on urologic procedures and antimicrobial prophylaxis[1] and the ASHP/IDSA 2013 antimicrobial prophylaxis in surgery guideline.[2]

A second and increasingly important framework is the device-specific evidence for IPP, AUS, mesh, and sacrocolpopexy — particularly the PUMP collaborative 2023–2025 data showing that AUA-recommended vancomycin-plus-gentamicin is associated with higher IPP infection rates than nonstandard alternatives, reshaping the prosthetic-urology antibiotic conversation. See Penile implants — infection and Prosthetic infection & biofilm protocols for the full device-specific detail.

Mechanism of Action​

Perioperative prophylaxis provides time-limited antimicrobial coverage during the window of maximum contamination risk — from skin incision to closure. The mechanistic requirements are:

  1. Adequate tissue concentration at time of incision → timing critical
  2. Broad enough coverage for expected contaminants → agent selection by procedure type
  3. Sufficient duration to cover the operative window → redose intravascular half-life
  4. Short enough total exposure to preserve microbiome and avoid resistance → single-dose or <24-hour courses

Agents Used​

AgentPrimary roleTypical dose (normal renal function)Redose interval
CefazolinWorkhorse for most urologic procedures; skin + common gram-negatives2 g IV (3 g if >120 kg)q4h
VancomycinMRSA coverage; β-lactam allergy (anaphylaxis history); prosthetic device cases15 mg/kg IV (max 2 g)q12h typically
GentamicinGram-negative coverage; prosthetic device cases (AUA BPS 2020)5 mg/kg IV (single dose)Single dose typically
Piperacillin-tazobactamBroad gram-negative + anaerobic coverage; urinary diversion / bowel-involving cases3.375 g IVq4h
CeftriaxoneAlternative to cefazolin; longer half-life1–2 g IVLong t½ — single dose usually sufficient
MetronidazoleAnaerobic coverage — combine with cephalosporin for bowel cases500 mg IVq8h
Clindamycinβ-lactam allergy; skin coverage900 mg IVq6h
Aztreonamβ-lactam allergy alternative with gram-negative coverage; no cross-reactivity2 g IVq8h
FluconazoleAntifungal — prosthetic device cases (PUMP data)400 mg IVSingle dose

Indications in Urology — AUA BPS 2020 Framework​

The AUA BPS categorizes urologic procedures by infection risk. Single-dose perioperative prophylaxis is the standard for most clean-contaminated procedures.[1]

Procedures WHERE prophylaxis IS indicated​

Clean-contaminated urologic procedures (those entering the GU tract):

ProcedurePreferred regimen
TURP / HoLEP / TURBTCefazolin 2 g IV; or aminoglycoside alone
Ureteroscopy / PCNLCefazolin or ciprofloxacin; treat asymptomatic bacteriuria first
UrethroplastyCefazolin; extend if BMG harvest / perineal incision
Sling / mesh / sacrocolpopexyCefazolin (vaginal approach) or cefazolin + metronidazole
IPP, AUSSee device-specific section below
Urinary diversion / cystectomyCefazolin + metronidazole, OR piperacillin-tazobactam (covers bowel)
Partial nephrectomy, radical nephrectomyCefazolin 2 g IV
Vasectomy (selected)Not routinely recommended; consider in high-risk patients

Procedures WHERE prophylaxis IS NOT ROUTINELY indicated​

  • Simple outpatient cystoscopy in healthy adults without infection risk factors[1][3]
  • Catheter exchange in the absence of bacteriuria
  • Urodynamic testing without instrumentation risk factors
  • Shock-wave lithotripsy in most patients (low infection risk)

Key principle: prophylaxis is not a substitute for treating pre-existing asymptomatic bacteriuria before mucosal-disrupting procedures.

Preoperative urine culture and asymptomatic bacteriuria​

The AUA BPS 2020 requires preoperative evaluation with dipstick, microscopy, and/or formal culture scaled to procedural risk, and explicitly warns that urine culture should not be interpreted without accompanying urine microscopy because sample contamination and benign colonization are common. Elective procedures should be deferred in the setting of active infection; urgent procedures in the setting of UTI should have current culture and sensitivity data available at the time of incision.[1]

IDSA asymptomatic-bacteriuria guideline (2019)[7] provides the cleanest framework:

Clinical scenarioIDSA 2019 recommendationStrength / evidence
Endoscopic urologic procedure with mucosal trauma (TURP, TURBT, URS)Screen for and treat ASBStrong / Moderate
Prior to AUS or penile prosthesis implantationDo not screen or treat ASBWeak / Very low
When treating ASB before a GU procedureUse culture-targeted therapy, not empiricWeak
Duration when treating ASB for GU procedure1–2 doses starting 30–60 min preop; not a prolonged courseWeak

The prosthetic-device exception exists because implant infections are typically caused by biofilm-producing skin flora rather than urinary pathogens — a retrospective analysis of 721 AUS and IPP cases found similar device-infection rates with and without preoperative bacteriuria (3% vs 4.3%), and only 1 of 15 device infections matched the preop urine organism.[7]

TOCUS database (Kutchukian 2024, n = 2,389 urologic procedures) — the largest prospective dataset on ASB as a surgical risk factor:[15]

  • Positive preop culture was an independent risk factor for postoperative febrile infection: mono-/bimicrobial OR 3.68; polymicrobial OR 2.85
  • UTI in the prior 12 months: OR 3.43
  • Operative time: OR 1.09 per unit
  • Systematic preventive antibiotic therapy for positive culture has not been conclusively shown to mitigate this risk — targeted culture-based prophylaxis per IDSA remains the best-defensible approach

Device-Specific Protocols​

Inflatable penile prosthesis (IPP)​

The area of most active contemporary debate. Historically the AUA BPS has recommended vancomycin + gentamicin, but PUMP collaborative data have shifted practice:[4][5]

  • Barham 2023 PUMP analysis (4,161 primary IPPs): vancomycin + gentamicin was associated with 2.7× higher infection risk than nonstandard regimens
  • Abou Chawareb 2025 (5,261 patients, 16 centers): perioperative IV antifungal use → 92% reduction in infection risk (OR 0.22)
  • Modern consensus regimen (tailored to local antibiogram): vancomycin + gram-negative agent (gentamicin, piperacillin-tazobactam, or ceftriaxone) + fluconazole 400 mg IV as a single perioperative dose stopped within 24 hours

Device coating matters:

  • InhibiZone (AMS 700): do NOT dip; rely on factory coating + field irrigation
  • Hydrophilic Titan (Coloplast): dip for ≥30 sec in vancomycin 1 g/L + gentamicin 80 mg/L; avoid 0.05% CHG (2026 Ivan J Urol data showed harm)

See Penile implants — infection for comprehensive detail.

Artificial urinary sphincter (AUS)​

  • Similar device-infection concerns to IPP
  • Vancomycin + gram-negative agent before incision; no additional antifungal demonstrated benefit specifically for AUS (but often given concurrent to IPP dosing)
  • Chlorhexidine skin prep, no-touch technique, no drain

Mesh / sacrocolpopexy​

  • Cefazolin 2 g IV is standard for vaginal approach
  • Cefazolin + metronidazole for abdominal sacrocolpopexy crossing peritoneum
  • MRSA nasal screening + decolonization in carriers before mesh placement (borrowed from orthopedic prosthetic practice)

National trend data — IPP and AUS prophylaxis in practice​

IPP (Brant 2023, n = 26,574 national cohort):[13]

  • 67% received AUA-adherent prophylaxis (typically vancomycin + gentamicin)
  • 42% relative increase in AUA-adherent regimen use after BPS publication
  • High-volume surgeons were more likely to be adherent (OR 2.21)
  • Non-adherence was not independently associated with 90-day explant risk (study not powered for this)

AUS (Sun 2023, n = 9,775 20-year national cohort):[14]

  • Only 44.1% received guideline-adherent prophylaxis, though adherence is trending up (+7.7% / year)
  • Guideline-adherent regimens reduced any complication (OR 0.83; 95% CI 0.74–0.93) and surgical revision (OR 0.85; 95% CI 0.74–0.96) within 90 days
  • No significant difference in infection (OR 0.89; 95% CI 0.68–1.17)

The signal these two datasets share: adherence to the AUA prosthetic regimen improves some downstream outcomes but does not independently drive the infection endpoint — consistent with the PUMP findings that vancomycin + gentamicin is not mechanistically sufficient for the skin/fungal flora that actually cause prosthetic infection.[4][5]

Prostate biopsy — transrectal vs transperineal​

Transrectal biopsy — a Class III / contaminated procedure​

TRUS-guided transrectal prostate biopsy carries a 5–7% infectious complication rate and a 0.3–9.4% sepsis rate; AP is mandatory per AUA BPS.[1]

Pilatz 2020 EAU systematic review and meta-analysis (59 RCTs, n = 14,153):[8]

  • AP reduced infectious complications vs no prophylaxis (RR 0.56; 95% CI 0.40–0.77; p = 0.0005)
  • Short-term prophylaxis (single shot to 3 days) was inferior to longer courses with fluoroquinolone (RR 1.89; p = 0.0001)
  • Fosfomycin trometamol was an effective alternative (RR 0.49; p = 0.02)
  • Targeted prophylaxis based on rectal-swab culture outperformed empiric prophylaxis (RR 1.81; p = 0.0008)
  • Augmented multi-agent regimens outperformed single-agent standard prophylaxis in fixed-effects modeling
  • Fluoroquinolone resistance is the rate-limiter here — rates exceed 30% for ciprofloxacin in many centers[18]

Transperineal biopsy — a clean procedure​

The transperineal needle tract does not cross rectal mucosa, making TP-Bx Class I / clean and raising the prospect that AP may be unnecessary.

NORAPP (Jacewicz 2022, Lancet ID, n = 1,008) — open-label non-inferiority RCT of AP vs no AP for transperineal biopsy under local anesthesia:[9]

  • Infection 0.0–1.1% and sepsis 0.0–1.5% — both arms
  • No evidence of increased infection without prophylaxis — non-inferiority established
  • Conclusion: AP can be safely omitted for transperineal biopsies in most patients

Cochrane 2025 (Xiao) confirms that empiric prophylaxis used for transperineal biopsy is extrapolated from the transrectal literature; the clean nature of the transperineal approach may not require routine AP. The EAU currently advises AP before TP-Bx pending further RCT validation, while the AUA has not published TP-Bx-specific guidance.[10]

Practice implication: the transrectal-to-transperineal shift is one of the largest contemporary opportunities to reduce urologic antibiotic consumption given ~2 million prostate biopsies performed annually between Europe and the US.[9]

Radical cystectomy — duration of prophylaxis​

Cystectomy with urinary diversion is the urologic operation most commonly associated with prolonged (>48 h) PAP in practice, driven by anxiety about urinary diversion, stents, and catheters. Contemporary evidence does not support this.

Thurnheer 2024 (JAMA Network Open, RCT) — the first RCT to directly address PAP duration in cystectomy with urinary diversion, testing whether ≤24 h PAP is non-inferior to an extended regimen continued until all catheters and stents are removed.[11]

Mohamed 2026 (systematic review and meta-analysis, 4 studies, n = 680):[12]

  • No difference between short-term (≤24 h) and extended PAP on:
    • SSI: RR 0.71 (95% CI 0.43–1.17; p = 0.18)
    • Febrile UTI: RR 1.19 (95% CI 0.91–1.56; p = 0.20)
    • Length of stay: MD 0.76 days (p = 0.67)
  • Conclusion: short-term (≤24 h) PAP is the recommended standard for cystectomy with urinary diversion

The medical literature does not support continuing antibiotics until catheter or stent removal — a common but unjustified practice pattern.[2][11]

Patient- and procedure-level risk factors for SSI​

Grabe 2012 EAU tentative classification[16] is still the best published stratification of urologic SSI risk:

DomainRisk factors
Patient — generalHigher ASA, advanced age, malnutrition / hypoalbuminemia, obesity, uncontrolled hyperglycemia, smoking, immune dysfunction
Patient — urologicBacteriuria, indwelling catheter, stone disease, obstruction, prior urogenital infection
Procedure-relatedSurgical-field contamination class, operative duration, tissue handling / invasiveness, length of postoperative catheterization

Seidelman 2023 JAMA SSI review[17] summarizes the cross-specialty evidence:

  • Administer within 60 minutes of incision
  • Cefazolin is the most commonly used agent; redose every 4 hours for lengthy procedures
  • A systematic review of 28 RCTs (n = 9,478) found additional postoperative doses did not reduce infection (OR 1.06; 95% CI 0.89–1.25)
  • Prolonged AP is increasingly associated with acute kidney injury and other harms
  • Stop antibiotics when the wound is closed

The Japanese urologic-prophylaxis guideline (Yamamoto 2016) adds the explicit 2-day cap for bowel surgery and the same ≤24-h cap for clean / clean-contaminated cases.[19]

Dosing & Administration​

warning

Doses listed are for reference only. Confirm with current guidelines and institutional protocols.

Timing​

  • Cephalosporins, clindamycin, aminoglycosides, metronidazole: administer within 60 minutes before incision
  • Vancomycin, fluoroquinolones: administer within 120 minutes before incision (longer infusion time)
  • Fluconazole: ≥30 minutes before incision

Redosing​

Redose for prolonged procedures to maintain tissue levels:

  • Cefazolin: every 4 hours
  • Piperacillin-tazobactam: every 4 hours
  • Clindamycin: every 6 hours
  • Vancomycin: typically no redose for <6 hour cases
  • Gentamicin: single dose usually sufficient (extended-interval dosing philosophy)
  • Metronidazole: every 8 hours
  • Significant blood loss (>1,500 mL) → redose cephalosporins regardless of time interval

Duration​

  • Single dose preoperatively is the standard for most clean-contaminated urologic procedures
  • <24 hours total is the maximum for almost all perioperative prophylaxis
  • PUMP data support stopping within 24 hours even for IPP — no benefit to prolonged IV courses or postoperative oral antibiotics[4]

Weight-based dosing​

  • Cefazolin: 2 g if <120 kg; 3 g if ≥120 kg
  • Vancomycin: 15 mg/kg actual body weight (max 2 g per dose)
  • Gentamicin: 5 mg/kg adjusted body weight

Contraindications & Precautions​

β-lactam allergy​

Reported allergyAlternative
True penicillin anaphylaxisVancomycin + aztreonam (no β-lactam cross-reactivity)
Mild penicillin rashCephalosporin (cefazolin) — cross-reactivity low (~1%)
Cephalosporin anaphylaxisVancomycin + aztreonam + gentamicin
Vancomycin-induced red-man / DRESSClindamycin; linezolid for MRSA if needed

The penicillin allergy re-evaluation movement: most patients labeled "penicillin allergic" can safely receive cephalosporins. Formal allergy evaluation is increasingly recommended for high-risk surgical patients.

Renal adjustment​

  • Cefazolin, cefepime, cefpodoxime: renal dose-adjusted
  • Aminoglycosides: renally cleared — monitor levels in prolonged courses
  • Fluoroquinolones: renal adjustment for ciprofloxacin, levofloxacin
  • Vancomycin: trough goals 15–20 mg/L for serious infections; adjust for renal function

Pregnancy​

  • Cefazolin, cephalosporins, penicillins — generally safe
  • Aminoglycosides — use if benefit outweighs risk; ototoxicity concern in fetus
  • Fluoroquinolones — avoid (limited data, animal cartilage concern)
  • TMP-SMX — avoid in 1st and 3rd trimesters

MRSA Screening and Decolonization​

For patients undergoing prosthetic device surgery (IPP, AUS, mesh):

StepProtocol
Nasal swab for MRSAAt preoperative visit
Decolonization if positiveMupirocin 2% ointment BID × 5 days + chlorhexidine body wash daily × 5 days
Vancomycin coverageAdd to preop cefazolin for confirmed MRSA carriers

Not indicated for clean procedures, simple cystoscopy, or low-risk ambulatory procedures.

Away from vancomycin + gentamicin for IPP​

PUMP data have reshaped the prosthetic-urology antibiotic conversation — local antibiogram-tailored regimens, addition of antifungals, and single-dose paradigms are increasingly favored over the traditional AUA recommendations.[4][5]

Away from prolonged postoperative antibiotics​

Multiple studies — most recently Dropkin 2020 and the 2025 Abou Chawareb analysis — confirm that postoperative oral antibiotics provide no benefit after urologic device surgery. Stewardship principles and microbiome considerations both point toward stopping within 24 hours.[6]

Fluconazole 400 mg IV for device cases​

The strongest modifiable signal in the contemporary IPP infection literature (92% reduction). Practice has shifted toward routine antifungal coverage for device surgery — not universal yet, but adoption is increasing.[5]

Reconsidering the penicillin-allergy label​

~10% of the population reports penicillin allergy; of these, ~90% can safely receive cephalosporins. Formal allergy evaluation before surgery is increasingly recommended.

Evidence Summary​

IndicationEvidence LevelKey Guideline / TrialNotes
Urologic procedural prophylaxis frameworkLevel 1AUA BPS 2020[1]Procedure-stratified
Surgical prophylaxis generalLevel 1ASHP/IDSA 2013 joint guideline[2]Timing, redose, duration
Cystoscopy prophylaxisLevel 1Zeng 2019 Cochrane[3]Not routinely indicated
Asymptomatic bacteriuria pre-procedureLevel 1IDSA 2019 ASB guideline[7]Treat before mucosal-disrupting GU surgery
IPP prophylaxis — modern dataLevel 1PUMP 2023–2025[4][5]; Dropkin 2020[6]AUA regimen is not superior; antifungal coverage strongest modifiable signal
Transrectal prostate biopsyLevel 1Pilatz 2020 EAU meta[8]Targeted > empiric; short-course inferior to longer FQ; fosfomycin an alternative
Transperineal prostate biopsyLevel 1NORAPP 2022[9]; Xiao 2025 Cochrane[10]AP can likely be omitted
Radical cystectomy PAP durationLevel 1Thurnheer 2024 RCT[11]; Mohamed 2026 meta[12]≤24 h non-inferior to extended
IPP and AUS guideline adherenceLevel 3Brant 2023[13]; Sun 2023[14]Improves some outcomes but not infection endpoint
ASB as SSI risk factorLevel 2TOCUS 2024[15]Positive culture OR 3.68 for febrile infection
SSI — general principlesLevel 1Seidelman 2023 JAMA[17]; Grabe 2012 EAU[16]Stop at wound closure; no postop doses

Practical Pearls​

  1. Cefazolin 2 g IV within 60 min of incision covers the vast majority of urologic operations.
  2. Weight-based dosing matters — 3 g cefazolin for patients ≥120 kg.
  3. Redose cefazolin every 4 hours for long cases and after >1,500 mL blood loss.
  4. Vancomycin needs 2 hours to infuse fully — call anesthesia before skin prep.
  5. Treat asymptomatic bacteriuria before mucosal-disrupting procedures — prophylaxis doesn't substitute.
  6. Cystoscopy alone does NOT need prophylaxis in healthy patients.
  7. Fluconazole 400 mg IV is the strongest modifiable signal for prosthetic-device infection prevention — strongly consider for IPP, and increasingly for AUS.
  8. Stop within 24 hours. Postoperative oral antibiotics do not prevent device infections and may promote resistance and microbiome disruption.
  9. MRSA screen + decolonize carriers before any prosthetic-device surgery.
  10. Re-evaluate the penicillin-allergy label — most labeled patients can safely receive cephalosporins after formal evaluation.
  11. Transperineal biopsy can usually skip AP — NORAPP non-inferiority supports this; the TR → TP shift is one of the largest contemporary antibiotic-stewardship opportunities in urology.[9][10]
  12. For transrectal biopsy, prefer targeted (rectal-swab-guided) over empiric prophylaxis — fluoroquinolone resistance exceeds 30% and empiric failure drives post-biopsy sepsis.[8][18]
  13. Radical cystectomy stops at 24 hours — the Thurnheer RCT and 2026 meta confirm extended PAP until catheter / stent removal adds no benefit and drives resistance.[11][12]
  14. Screen and treat ASB before endoscopic mucosal-disrupting procedures (TURP/TURBT/URS); do not screen before IPP or AUS — the IDSA 2019 split is driven by the different microbiology of biofilm-producing skin flora vs urinary pathogens.[7]
  15. For TOCUS-defined high-risk patients (prior UTI within 12 months, positive preop culture, long operative time) escalate surveillance even when AP is given — systematic positive-culture prophylaxis has not been shown to fully neutralize this risk.[15]

References​

1. Lightner DJ, Wymer K, Sanchez J, Kavoussi L. Best practice statement on urologic procedures and antimicrobial prophylaxis. J Urol. 2020;203(2):351–356. doi:10.1097/JU.0000000000000509

2. Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195–283. doi:10.2146/ajhp120568

3. Zeng S, Zhang Z, Bai Y, Sun Y, Xu C. Antimicrobial agents for preventing urinary tract infections in adults undergoing cystoscopy. Cochrane Database Syst Rev. 2019;2:CD012305. doi:10.1002/14651858.CD012305.pub2

4. Barham DW, Pyrgidis N, Gross MS, et al. AUA-recommended antibiotic prophylaxis for primary penile implantation results in a higher, not lower, risk for postoperative infection: a multicenter analysis. J Urol. 2023;209(2):399–409. doi:10.1097/JU.0000000000003071

5. Abou Chawareb E, Hammad MAM, Azad B, et al. Perioperative antimicrobial strategies in inflatable penile prosthesis surgery. J Urol. 2025;214(6):642–653. doi:10.1097/JU.0000000000004716

6. Dropkin BM, Chisholm LP, Dallmer JD, Johnsen NV, Milam DF, Kaufman MR. Penile prosthesis insertion in the era of antibiotic stewardship — are postoperative antibiotics necessary? J Urol. 2020;203(3):611–614. doi:10.1097/JU.0000000000000578

7. Nicolle LE, Gupta K, Bradley SF, et al. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clin Infect Dis. 2019;68(10):e83–e110. doi:10.1093/cid/ciy1121

8. Pilatz A, Dimitropoulos K, Veeratterapillay R, et al. Antibiotic prophylaxis for the prevention of infectious complications following prostate biopsy: a systematic review and meta-analysis. J Urol. 2020;204(2):224–230. doi:10.1097/JU.0000000000000814

9. Jacewicz M, Günzel K, Rud E, et al. Antibiotic prophylaxis versus no antibiotic prophylaxis in transperineal prostate biopsies (NORAPP): a randomised, open-label, non-inferiority trial. Lancet Infect Dis. 2022;22(10):1465–1471. doi:10.1016/S1473-3099(22)00373-5

10. Xiao YT, Yang Y, Wu X, et al. Antibiotic prophylaxis for transperineal prostate biopsy. Cochrane Database Syst Rev. 2025;10:CD015990. doi:10.1002/14651858.CD015990

11. Thurnheer MC, Schürmann A, Huber M, et al. Perioperative antibiotic prophylaxis duration in patients undergoing cystectomy with urinary diversion: a randomized clinical trial. JAMA Netw Open. 2024;7(10):e2439382. doi:10.1001/jamanetworkopen.2024.39382

12. Mohamed T, Bani Irshid BA, Elhashamy H, et al. Optimal duration of perioperative antibiotics in radical cystectomy and urinary diversion: a systematic review and meta-analysis. Langenbecks Arch Surg. 2026. doi:10.1007/s00423-025-03943-x

13. Brant A, Lewicki P, Punjani N, et al. Trends in antimicrobial prophylaxis for inflatable penile prosthesis surgery from a large national cohort. Urology. 2023;172:131–137. doi:10.1016/j.urology.2022.11.010

14. Sun HH, Callegari M, Zhou E, et al. Trends over 20 years of antimicrobial prophylaxis for artificial urinary sphincter surgery. Neurourol Urodyn. 2023;42(6):1421–1430. doi:10.1002/nau.25206

15. Kutchukian S, Gondran-Tellier B, Dinh A, et al. Asymptomatic bacteriuria and urological surgery: risk factor or not? Results from the national and multicenter TOCUS database. J Urol. 2024;212(3):461–469. doi:10.1097/JU.0000000000004047

16. Grabe M, Botto H, Cek M, et al. Preoperative assessment of the patient and risk factors for infectious complications and tentative classification of surgical field contamination of urological procedures. World J Urol. 2012;30(1):39–50. doi:10.1007/s00345-011-0722-z

17. Seidelman JL, Mantyh CR, Anderson DJ. Surgical site infection prevention: a review. JAMA. 2023;329(3):244–252. doi:10.1001/jama.2022.24075

18. Marino Sabo E, Stern JJ. Approach to antimicrobial prophylaxis for urology procedures in the era of increasing fluoroquinolone resistance. Ann Pharmacother. 2014;48(3):380–386. doi:10.1177/1060028013517661

19. Yamamoto S, Shigemura K, Kiyota H, et al. Essential Japanese guidelines for the prevention of perioperative infections in the urological field: 2015 edition. Int J Urol. 2016;23(10):814–824. doi:10.1111/iju.13161