Comparison of guideline recommendations for antimicrobial prophylaxis in urologic procedures: variability, lack of consensus, and contradictions

Ivan, Samuel J.; Sindhwani, Puneet

doi:10.1007/s11255-018-1971-1

Cited by 23 publications

(10 citation statements)

References 115 publications

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“…However, guideline recommendations on AP in TURB rely on outdated and underpowered trials [8]. This leads to a low level of evidence and overt discrepancies in international guideline recommendations ranging from complete AP omission to complete AP application for several days [7].…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, in contrast to transurethral resection of the prostate (TURP) [5,6], UTI rates are lower following TURB, and there appears to be little evidence for any benefit of AP. A lack of consensus was demonstrated in a recently published review that investigated the guidelines of the American Urological Association (AUA) and the Canadian (CAU), European (EAU), and Japanese (JAU) Associations of Urology [7]: The AUA considers TURB along with TURP and consequently AP should be applied to all patients, whereas the CAU groups TURB with cystoscopy and recommends AP only in high-risk patients. JAU guidelines recommend AP for TURB based on data for other transurethral procedures but state that low-risk cases without preoperative UTI can be considered to require no AP.…”

Section: Introductionmentioning

confidence: 99%

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Antibiotic prophylaxis in transurethral resection of bladder tumours: study protocol for a systematic review and meta-analysis

et al. 2020

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Background: The necessity of antibiotic prophylaxis for postoperative urinary tract infections (UTIs) after transurethral resection of bladder tumours is controversial. This potentially leads to the overuse of antibiotic prophylaxis and rising antimicrobial resistance rates. The objective of this systematic review and meta-analysis is to compare the impact of different antimicrobial prophylaxis schemes versus placebo on the prevention of postoperative UTI and asymptomatic bacteriuria. Methods: We designed and registered a study protocol for a systematic review and meta-analysis of randomized controlled trials and non-randomized (e.g. cohort, case-control) studies examining any form of antibiotic prophylaxis in patients with transurethral resection of bladder tumours. Literature searches will be conducted in several electronic databases (from inception onwards), including MEDLINE (Ovid), EMBASE (Ovid), and the Cochrane Central Register of Controlled Trials (CENTRAL). Grey literature will be identified through searching conference abstracts. The primary outcome will be postoperative urinary tract infections. The secondary outcome will be asymptomatic bacteriuria. Two reviewers will independently screen all citations, full-text articles, and abstract data. Potential conflicts will be resolved through discussion. The study methodological quality (or bias) will be appraised using appropriate tools (e.g. Risk of Bias 2.0 tool and Newcastle-Ottawa Scale). If feasible, we will conduct random-effects meta-analysis of outcome data. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g. study design, publication year, the setting of the study, and antibiotics regimen). We will also search, identify, and discuss potential risk factors for urinary tract infections following transurethral resection of bladder tumours. This may serve as basis for a scoping review. Discussion: In times of rising antimicrobial resistance rates, sound evidence on the necessity of antibiotic prophylaxis is essential for implementation into guideline recommendations and for decision-making in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Antibiotic prophylaxis in transurethral resection of bladder tumours: study protocol for a systematic review and meta-analysis

et al. 2020

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“…B. eine große Tumorgröße [36]. Zudem wurde per se eine geringe Evidenzlage für den Eingriff der TUR-Blase im Hinblick auf die Antibiotikaprophylaxe beschrieben, im Gegensatz zur TUR-Prostata und zur Prostatabiopsie [36,37]. Entsprechend der aktuellen EAU-Leitlinie besteht somit bei der TUR-Blase nur für Patienten mit hohem Risiko für eine postoperative Sepsis eine schwache Indikation für eine perioperative antibiotische Prophylaxe [38].…”

Section: Infektionenunclassified

Komplikationsmanagement bei der TUR-Blase

Mally

Paffenholz

2020

Aktuelle Urol

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ZusammenfassungDie transurethrale Resektion der Harnblase (TUR-Blase) ist ein Standardeingriff der operativen Urologie. Eine komplette Resektion steht hierbei an höchster Stelle. Darüber hinaus ist die Kenntnis der möglichen Komplikationen und das dazugehörige Komplikationsmanagement für die klinische Praxis essenziell. Zu den häufigsten Komplikationen gehören katheterassoziierte Beschwerden, Blutungen, Infektionen und die Harnblasenperforation. Doch auch die Resektion des Harnleiterostiums und Lagerungsschäden stellen zwar seltenere, aber dennoch unmittelbar behandlungswürdige Komplikationen dar. In der vorliegenden Übersichtsarbeit werden diese Komplikationen zusammengefasst sowie deren Vorbeugung und Management vorgestellt.

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“…In the current era of rising antibiotic resistance pathogens, such as Vancomycin Resistant Enterococcus (VRE), High Level Aminoglicoside Resistant Enterococcus (HLAR) or Enterobacterales with Extended-Spectrum Beta-Lactamases (ESBL) and New Delhi Metallo-β-lactamase (NDM) are becoming more frequent [ 1 ]. We found that previously used recommendations for the management of patients, including the principles of antibiotic prophylaxis were often inadequate in those with a colonized urinary tract that had no symptoms of urinary tract infection – which is commonly known as asymptomatic bacteriuria (ABU) [ 2 , 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Preliminary trial of 24 vs 72 hour perioperative meropenem in patients with ESBL-producing Enterobacterales bacteriuria scheduled for urological procedures

Radko

Guzek

Syryło

et al. 2022

Cent european J Urol

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Introduction Antimicrobial prophylaxis is an important issue in positive urine culture patients undergoing endourological procedures or extracorporeal shock wave lithotripsy (ESWL). It is especially recognized in asymptomatic bacteriuria patients of alarm pathogen etiology. We designed a preliminary study to determine optimal duration of antibiotic prophylaxis in patients undergoing endourological procedures or ESWL with asymptomatic bacteriuria caused by Enterobacterales with extended spectrum beta-lactamase positive (ESBL+) type resistance. Material and methods A total of 60 patients with confirmed ESBL+ Enterobacterales bacteriuria were admitted for endourological procedures or ESWL. The patients were randomized into two groups – a one-day (n = 33) and a three-day (n = 27) period of perioperative antibiotic prophylaxis with meropenem. In both groups on the following day after the procedure (24 hours after the procedure) and 7 days after the procedure serum inflammation markers were assessed. Results Values of white blood count, C-reactive protein and procalcitonin prior to, 24 hours and seven days after the procedure clearly showed no statistically significant differences between groups that have received a one-day and three-day antibiotic regimen. Conclusions In patients with ESBL+ Enterobacterales asymptomatic bacteriuria undergoing endourological procedures or ESWL a 72-hour perioperative meropenem prophylaxis showed no superiority over a 24-hour regimen. Further studies will be carried out to establish optimal prophylaxis for specific endourological procedures and to test safety of a single dose regimen.

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Comparison of guideline recommendations for antimicrobial prophylaxis in urologic procedures: variability, lack of consensus, and contradictions

Cited by 23 publications

References 115 publications

Antibiotic prophylaxis in transurethral resection of bladder tumours: study protocol for a systematic review and meta-analysis

Antibiotic prophylaxis in transurethral resection of bladder tumours: study protocol for a systematic review and meta-analysis

Komplikationsmanagement bei der TUR-Blase

Preliminary trial of 24 vs 72 hour perioperative meropenem in patients with ESBL-producing Enterobacterales bacteriuria scheduled for urological procedures

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