Antibiotic Prophylaxis of Urinary Tract Infection after Transurethral Resection of the Prostate: a Randomized Study

Abstract

Transurethral resection of the prostate is associated with a major risk of postoperative infection. To evaluate the clinical and bacteriological efficacy of antibiotic prophylaxis with a single dose of netilmicin sulfate, we conducted a randomized study in 100 patients with sterile preoperative urine undergoing transurethral resection of the prostate. Of these patients 95 were evaluated: 47 were randomized to the control group and received an intramuscular injection of 1.5 ml. of a 0.9 per cent solution of sodium chloride 1 hour preoperatively and 48 were given an intramuscular injection of 150 mg. netilmicin sulfate in a volume of 1.5 ml. 1 hour preoperatively. Of the patients 16 in the control group (34 per cent) and only 1 in the treated group (2 per cent) had bacteriuria (greater than 10(5) bacteria per ml.) (p less than 0.001). This difference also was significant 2 and 5 days postoperatively (p less than 0.05 and p less than 0.001, respectively). One patient in the control group had bacteremia compared to none in the treated group. Clinical signs of infection were less common in the treated group. Sensitivity studies revealed that all of the organisms tested were sensitive to netilmicin sulfate. High concentrations of netilmicin sulfate were found in the urine collected at operation (162 +/- 112 micrograms per ml. urine).

Efficacy of Prophylactic Gentamicin Use in Postoperative Urinary Tract Infections after Endoscopic Procedures of the Urinary Tract

“…Although not confirmed universally, a UTI rate of 45%, even after sterile urethral instrumentation, was reported in 1976 by Korbel and Maher [4], but as men tioned previously, the endoscopic manipulations of the urinary tract have become a safe procedure by the devel opment of the endoscopic devices and antiseptic solu tions [1]. The risk of UTI in patients with preoperative sterile urine is very low and prophylaxis is not recom mended routinely [2,5,6], On the other hand, the high incidence of infection after T U R-P has been reported reaching a rate of 30-50% in cases without antibiotic pro phylaxis [1].…”

“…Endoscopic manipulations of the urinary tract have become a safe and well-tolerated procedure with the development of new endoscopic devices and more effica cious antiseptic solutions [1]. Although significant infec tious complications are not seen frequently in patients with preoperatively sterile urine, the incidence of urinary tract infection (UTI) after sterile urethral instrumentation was reported as high as 45% [2].…”

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

“…Recently, it was reported that such culturing did not affect the incidence of fever, chills, epididymitis and urinary tract infection during the postoperative period after transurethral resection of the prostate. 8,12 On the other hand, in patients who have a positive urine culture at the time of the operation, the occurrence of fever, bacteremic episodes and postoperative urinary tract infection can be minimized by prior treatment, as shown by other authors. [12][13][14][15] This seems to be the rationale for the usage of antibiotic.…”

“…2 Recently, it was reported that the incidence of bacteremic episodes with clinical expression represented by chills or fever ranged from 2 to 52% of the cases. 7,8 The source of the bacteria responsible for the chills can theoretically be the prostate gland, an ascending route outside of the catheter, the irrigating fluid or the catheter itself during and after transurethral resection of the prostate. 2,5,9 According to most researchers, the prostate gland is the ultimate source of bacteremic episodes and is the origin of urine contamination following transurethral resection of the prostate, [10][11][12] even though the bacteria recovered from the urine and glandular tissue are the same in only 36 to 50% of cases.…”

Altered tobramycin pharmacokinetics during chemoprophylaxis in bladder surgery

“…Gram-negative bacteria, the most frequent cause of infection in the urinary tract, are a major problem in patients who undergo total cystectomy (3,4,21). In bladder surgery, the efficacy of prophylaxis is related as much to the urinary concentration of antibiotic as to the level of antibiotic in serum.…”