A randomized and prospective study on the value of antibiotic prophylaxis administration in transurethral resection of the prostate

Abstract

CONTEXT: Antibiotic prophylaxis in transurethral resection of the prostate is a regular practice in urology. However, its prophylactic effect can be questioned when the antiseptic surgical technique is used. Nonetheless, urine culture-oriented antibiotic therapy is the gold standard for avoiding improper medication usage and bacterial resistance. OBJECTIVE: To study the efficacy of antibiotic usage in patients with negative urine cultures, who were submitted to transurethral resection of the prostate. TYPE OF STUDY: Prospective open labeled study. SETTING: Tertiary care referral hospital PARTICIPANTS: 124 consecutive patients, who were randomly divided into two groups to receive antibiotic prophylaxis or not. MAIN MEASUREMENTS: Cultures from meatus, urine, irrigation and antiseptic fluid, and prostate tissue chips, were compared and analyzed for bacterial sensitivity to the antibiotic used, according to the surgeon's personal criteria. McLennan's test was used for statistical analysis. RESULTS: No statistically significant difference regarding clinical evolution was found between the groups that received or antibiotics or not. Statistical significance was found regarding the occurrence of positive urine cultures during the postoperative period for those not receiving antibiotics, but not in relation to fever, prostate chip culture or bacteremic episodes. Sixty-eight subjects (57.1%) presented positive prostatic tissue culture. There was no specific correlation between the recovered bacteria from the meatus, prostatic tissue chip and urine and the spectrum of the administered antibiotic. Six cases showed the same bacteria in the urine and prostatic tissue chip. Only fifteen cases (25%) in the antibiotic group showed the desired sensitivity directed to the collected bacteria. CONCLUSIONS: Antibiotic prophylaxis for patients whose urine is sterile is debatable in patients who are candidates for transurethral resection of the prostate. Most of the time, the antibiotic agent used is not specific for any of the bacteria recovered from the various sources analyzed.

Risk factors, antibiotic prophylaxis, and treatment of urinary tract infection in transurethral surgery for benign prostatic hyperplasia

“…Что касается длительности антибиотикопрофилактики, в исследовании T. Cai et al (2016), оценившем эффективность соблюдения руководящих принципов EAU по профилактике АБп, режим однократного приёма снизил общее использование АБп без увеличения частоты послеоперационных инфекций и сократил распространённость резистентных уропатогенов [27]. по данным P. Rodrigues et al (2004), частота выявления микроорганизмов из ткани простаты была одинаковой и в группе пациентов, получавших антибиотикотерапию, и в группе без неё [21].…”

Assessment of Antibiotic Prophylaxis Prescribing Patterns for TURP: A Need for Canadian Guidelines?

“…4,6,10 Recognized sources of infection include urethral bacterial flora, urethral catheters, intra-operative or postoperative surgical contamination, and infection transferred from a distant sites. 8,[11][12][13][14][15] Moreover, factors which can contribute to increase in risk of post-TURP UTI include presence of preoperative infected urine, indwelling catheter, advanced age, anatomic abnormalities of the urinary tract, smoking, immune-suppression and prolonged hospitalization. 5,13,16,17 There is strong evidence supporting the use of prophylactic antibiotics prior to TURP procedure.…”