Antimicrobial Prophylaxis for Postoperative Urinary Tract Infections in Transurethral Resection of Bladder Tumors: A Systematic Review and Meta-Analysis

Bausch, Kathrin; Halbeisen, Florian S.; Aghlmandi, Soheila; Sutter, Sarah Ursula; Ewald, Hannah; Appenzeller-Herzog, Christian; Roth, Jan A; Widmer, Andreas F.; Seifert, H.

doi:10.1097/ju.0000000000001513

Cited by 7 publications

(8 citation statements)

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“…Bausch et al, 99 in a meta-analysis including seven studies (1725 patients), showed no significant effect of AP on postoperative UTIs incidence [OR 1.55, 95% CI 0.73-3.31] and ASB [OR 0.43, 95% CI 0.18-1.04]. Age, preoperative pelvic radiation, preoperative ASB, and pyuria have been identified as risk factors for UTIs following TURB.…”

Section: Transurethral Resection Of Bladder Tumormentioning

confidence: 99%

Antibiotic prophylaxis in urologic interventions: Who, when, where?

Marino,

Rossi,

Murri

et al. 2024

Urologia

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Background: Periprocedural prophylaxis in medicine encompasses the set of measures (physical, chemical, and pharmacological) used to reduce the risk of infection. Antibiotic prophylaxis (AP) refers to the administration of a short-term regimen of antibiotics shortly before a medical procedure to reduce the risk of infectious complications that can result from diagnostic and therapeutic interventions. The outspreading growth of multidrug-resistant bacterial species and changes in the bacterial local ecosystem have impeded the development of a unique scheme of AP in urology. Objectives: To review the literature and current guidelines regarding AP for urological diagnostic and therapeutic procedures, and to define agents, timing, and occasions when administering pharmacological prophylaxis. Secondly, according to current literature, to open new scenarios where AP can be useful or useless. Results: Major gaps in evidence still exist in this field. AP appears useful in many invasive procedures and some sub-populations at risk of infectious complications. AP is not routinely recommended for urodynamic exams, diagnostic cystoscopy, and extracorporeal shock-wave lithotripsy. The available data regarding the use of AP during the transperineal prostate biopsy are still unclear; conversely, in the case of the transrectal approach AP is mandatory. AP is still considered the gold standard for the prevention of postoperative infective complications in the case of ureteroscopy, percutaneous nephrolithotomy, endoscopic resection of bladder tumor, endoscopic resection of the prostate, and prosthetic or major surgery. Conclusion: The review highlights the complexity of determining the appropriate candidates for AP, emphasizing the importance of considering patient-specific factors such as comorbidities, immunocompetence, and the nature of the urologic intervention. The evidence suggests that a one-size-fits-all approach may not be suitable, and a tailored strategy based on the specific procedure and patient characteristics is essential.

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Section: Transurethral Resection Of Bladder Tumormentioning

confidence: 99%

Antibiotic prophylaxis in urologic interventions: Who, when, where?

Marino,

Rossi,

Murri

et al. 2024

Urologia

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“…Calculation of the OIS follows the same principles as for calculating the power for a single study, with estimates of realistic event rates and the minimum effect of treatment that would be worthwhile (see the example in Fig. 1 [10]). Informally, Grading of Recommendations, Assessment, Development and Evaluations (GRADE) gives a rule of thumb that we should question the imprecision of a metaanalysis if the total number of patients included is less than the number of patients generated by a conventional sample-size calculation for a single adequately powered trial [8].…”

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confidence: 99%

“…Consider an example of a meta-analysis in which the difficulties of a low event rate and a low sample size meet. A systematic review and meta-analysis of the effect of antimicrobial prophylaxis for transurethral resection of bladder tumor examined postoperative urinary tract infections as the outcome [10]. Six studies were included, the event rate in both groups was low (antimicrobial prophylaxis 3.74%; no antimicrobial prophylaxis 2.98%), and the meta-analysis did not reveal a significant effect of prophylaxis on postoperative urinary tract infection (OR 1.41, 95% CI 0.96-2.54).…”

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confidence: 99%

Evidence-based Urology: When Is a Study or Meta-analysis Big Enough?

Bausch

Cartwright

2021

European Urology Focus

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Both designing a clinical study and drawing conclusions from studies about the effect of treatments require justification of the sample size via judicious choice of the endpoint and power. Such an a priori power calculation limits the chances of mistakenly claiming a lack of clinical significance if no statistically significant difference between two treatments can be detected. Calculating the sample size for a new trial furthermore requires assessment of existing evidence to determine if its results will contribute to an updated meta-analysis. To rate the power of a meta-analysis, determination of the optimal information size is suggested, following the same principles as for calculating the power of a single trial. Even though these sample size considerations might seem like an additional hurdle, they are necessary to conduct clinical studies and meta-analysis that provide the optimal benefit for both clinicians and patients. Patient summary: Before conducting a clinical trial, researchers should determine how many patients need to be included to detect a difference between treatments. Even though a study might find a statistical difference between treatments, this does not necessarily mean that the difference is relevant for clinical use. These analyses before starting a study are important for producing worthwhile usable evidence for clinicians and patients.

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“…2 Nowadays, many urologists give 1 or more doses of antimicrobial drugs as antimicrobial prophylaxis (AMP) to patients who undergo TURB. This practice is probably based on common habits but remarkably, as stated by Bausch et al in their recent review, 3 there is an absence of evidence in the literature demonstrating that using AMP before routine TURB reduces the risks of infection complications. 4 So far, in the age of evidence-based medicine, the study of Bausch et al importantly underlines the need for better quality evidence in sustaining or not the very common practice of the use of AMP for patients who undergo TURB.…”

mentioning

confidence: 99%

“…This practice is probably based on common habits but remarkably, as stated by Bausch et al in their recent review, 3 there is an absence of evidence in the literature demonstrating that using AMP before routine TURB reduces the risks of infection complications. 4 So far, in the age of evidence-based medicine, the study of Bausch et al importantly underlines the need for better quality evidence in sustaining or not the very common practice of the use of AMP for patients who undergo TURB. Interestingly enough, the answer to the question, “Does AMP reduce the rate of postoperative symptomatic urinary tract infection in patients undergoing TURB?” could be negative.…”

mentioning

confidence: 99%