Antibiotic prophylaxis for transurethral urological surgeries: Systematic review

Abstract

The use of antibiotic prophylaxis to prevent urinary tract infection and bacteremia (sepsis) following endoscopic urologic procedures is a controversial topic. Evidence in the literature revealed that urological instrumentation is associated with increased incidence of urinary tract infection and bacteremia. The aim of this review is to evaluate the effectiveness of antibiotic prophylaxis in reducing the risk of urinary tract infection in patients who had transurethral urological surgeries. We have selected all RCTs of adult population who underwent all different types of transurethral urological surgery, including cystoscopy, transurethral resection of prostate and transurethral resection of bladder tumor, and received prophylactic antibiotics or placebo/no treatment. At first, more than 3000 references were identified and reviewed; of which 42 studies with a total of 7496 patients were included in the final analysis. All those trials were analyzing antibiotic prophylaxis versus placebo/no treatment, and they were significantly favoring antibiotic use in reducing all outcomes, including bacteriuria (RR 0.36, 95% CI 0.29 to 0.46, P < 0.0001) with moderate heterogeneity detected (I2 48%), symptomatic UTI (RR 0.38, 95% CI 0.28 to 0.51, P < 0.0001) with no significant heterogeneity was detected (I2= 17%), bacteremia (RR 0.43, 95% CI 0.23 to 0.82, P < 0.0001) with no noted heterogeneity (I2 = 0%), and fever ≥38.5 Celsius (RR 0.41, 95% CI 0.23 to 0.73, P = 0.003); also, there was no noted heterogeneity (I2 = 0%). However, using antibiotic prophylaxis did not reduce the incidence of low grade temperature (RR 0.82, 95% CI 0.61 to 1.11, P = 0.20) or in moderate grade temperature (RR 1.03, 95% CI 0.71 to 1.48, P = 0.89). Antibiotic prophylaxis appears to be an effective intervention in preventing urinary tract infections and its sequels following transurethral urological surgeries in patients with preoperative sterile urine.

Predictive Model of Preoperative Bacteriuria in Urological Surgery

“…The best studied urological procedure is transurethral resection of the prostate: there are two large meta analysis with prospective and randomized studies that show an important benefit of antibiotic prophylaxis with a relative risk reduction of bacteriuria of 65% [68]. Nevertheless, in a transurethral resection of the bladder, recent recommendations advise to get antibiotic prophylaxis in function of the size of the tumor [9]. In the case of ureteroscopic procedures, the factors we have to take into account are the presence of stone and his anatomic position as well as a history of urinary tract infections [10].…”

Complicaciones infecciosas después de prostatectomía abierta y resección transuretral de próstata en pacientes con hiperplasia prostática benigna

“…Esta es solo una de las varias medidas que reducen la infección del sitio operatorio y se recomienda solo cuando el beneficio potencial excede el riesgo y los costos anticipados. En la cirugía prostática la evidencia indica que disminuye la incidencia de bacteriuria, bacteriemia e ITU (43,44).…”

Multifocal Synchronous Chromophobe, Papillary, and Clear Cell Renal Cell Carcinoma in a Single Kidney

“…Antimicrobial prophylaxis is not recommended as a standard application in extracorporeal shock wave lithotripsy (35). However, it is indicated to use prophylaxis for the control of bacteriuria and in elevated bacterial load, such as permanent catheter, nephrostomy tube, or presence of infective stones (44).…”

“…The frequency of infectious complications reported after cystoscopy, standard urodynamic investigation and ureteroscopy is very low if the urine is sterile in the preoperative period (35). Routine antimicrobial prophylaxis is not recommended due to the frequency of diagnostic cystoscopy, low risk of infection, and developing bacterial resistance (34).…”