Pathogen species are the risk factors for postoperative infection of patients with transurethral resection of the prostate: a retrospective study

Abstract

This study aimed to analyze the infection risk factors for transurethral resection of the prostate (TURP) and establish predictive models to help make personalized treatment plans. Our study was designed one-center and retrospectively enrolled 1169 benign prostatic hyperplasia (BPH) patients. Risk factors were explored for postoperative infection. A TURP-postoperative infection (TURP-PI) model with infection prediction values was created. The improved-TURP-PI (I-TURP-PI) model, including extra new factors (pathogens species), was also built to see whether it could optimize the prediction abilities. At last, we developed a nomogram for better clinical application. Operation time, preoperative indwelling urinary catheter (PIUC), and positive preoperative urine culture were independent risk factors (all P < 0.05). Interestingly, pathogens species in pre-surgery urine (PEnterococcus faecium = 0.014, PPseudomonas aeruginosa = 0.086) were also independent risk factors. Patients with positive Enterococcus faecium (37.50%) were most likely to have postoperative infection. We built two models with AUCTURP-PI = 0.709 (95% CI 0.656–0.763) and AUCI-TURP-PI = 0.705 (95% CI 0.650–0.760). The nomogram could help improve the prediction ability. To our knowledge, our study is the first to use pathogen species in urine before surgery as risk factors for infection prediction after TURP. TURP-PI and I-TURP-PI models have essential roles in predicting patients' postoperative infections and in better postoperative antibiotic decision-making.

It is not the best option to perform transurethral enucleation of the prostate immediately after biopsy in patients with histological inflammation

“…Xu et al ( 14 ) conducted an analysis on the risk factors for urinary tract infections after prostatic hyperplasia surgery, revealing that BPH patients with prostatitis faced a significantly heightened risk of postoperative infection and fever, both of which could be effectively mitigated through the administration of antibiotics. This phenomenon may be attributed to the destruction of prostate tissue during surgical procedures and the subsequent rise in pressure due to intraoperative perfusion, leading to the infiltration of inflammatory mediators into the bloodstream ( 15 ). It remains to be confirmed through additional clinical studies whether preoperative administration of anti-inflammatory therapy to patients with BPH combined with PI can effectively mitigate the likelihood of postoperative infections.…”