Introduction: Due to the overlapping symptoms between ureteric stents and infectious cystitis, patients are at increased risk of antibiotic overexposure. Our objective was to assess provincial trends in antibiotic and multidrug-resistant organisms (MDRO) in patients with ureteric stents.

Methods: A retrospective, provincial cohort of patients undergoing ureteric stent insertion (SI) was created using administrative and clinical data through Alberta’s Data Integration, Management, and Reporting unit (2013–2018). Those with concurrent extirpative and reconstructive surgeries were excluded. Data one year pre- and post-SI was collected. Patients with urine cultures (UC) growing MDRO (microbes resistant to >3 antibiotics) were identified and analyzed based on pre-SI UC status (no growth [NG], sensitive organisms [SO], and MDRO).

Results: A total of 13 820 SI were completed over the five-year period. MDRO increased from 1.2% (n=164) to 5.9% (n=815) after SI; 42% of these stents were placed for hydronephrosis and 21% for stones. Forty percent underwent repeat SI in the following year. A total of 217 patients with NG and 434 with SO developed MDRO post-SI, within 2.9 and 2.7 prescriptions, respectively. Patients with pre-SI MDRO were more likely to receive antibiotic prescriptions in the following year (NG 5.5 vs. SO 5.7 vs. MDRO 7.0) and received ciprofloxacin 24% of the time. Unplanned emergency visits were similar post-SI (4.0 vs. 4.0 vs. 4.7, p=0.23) but pre-SI MDRO had significantly more emergency visits in the year prior (2.6 vs. 3.1 vs. 4.3, p<0.0001).

Conclusions: Ureteral stents pose a significant risk for developing MDRO, even when starting with negative urine cultures. Patients with MDRO are more likely to be re-stented, receive more antibiotics, and present to the emergency department. Given these complicating features, stented patients warrant careful consideration of their microbiology and antibiotic exposures.