Prostatectomy and prophylaxis

Bannister, G.C.; Dg, Arkell; Ap, Menday

doi:10.1093/jac/7.2.209

Cited by 8 publications

(4 citation statements)

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“…Finally, 42 original reports of trials were identified as meeting inclusion criteria for data extraction and were included in the final meta-analysis. [31428–67]…”

Section: Resultsmentioning

confidence: 99%

Antibiotic prophylaxis for transurethral urological surgeries: Systematic review

Alsaywid¹,

Smith²

2013

Urol Ann

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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.

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“…Finally, 42 original reports of trials were identified as meeting inclusion criteria for data extraction and were included in the final meta-analysis. [31428–67]…”

Section: Resultsmentioning

confidence: 99%

Antibiotic prophylaxis for transurethral urological surgeries: Systematic review

Alsaywid¹,

Smith²

2013

Urol Ann

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“…6,[18][19][20][21][22][23][24][25] This is further supported by a RCT demonstrating equivalent outcomes with the use of levofloxacin versus TMP-SMX as antibiotic prophylaxis for TURP. 2 As such, the wide variety of antibiotic regimens used by urologists at our institution is understandable as no single agent stands out as superior with respect to efficacy (Fig.…”

Section: Discussionmentioning

confidence: 78%

“…4 Clinical efficacy was shown for antibiotic classes including fluoroquionolones, third generation cephalosporins, aminoglycosides and trimethroprim-sulfamethoxazole (TMP-SMX). [18][19][20][21][22][23][24][25] Based on the available evidence, the 2008 American Urology Association (AUA) Best Practice Statements (BPS) on Urologic Surgery Antimicrobial Prophylaxis recommends use of prophylactic antibiotics for all patients undergoing TURP. 1 The recommended first-line agents are fluoroquinolones or TMP-SMX, with alternatives including aminoglycosides alone or with ampicillin, cephalosporins or amoxicillin/clavulanate <24 hours prior to TURP.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Antibiotic Prophylaxis Prescribing Patterns for TURP: A Need for Canadian Guidelines?

Lawson

Rudzinski

Vicas

et al. 2013

CUAJ

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Background: While antibiotic prophylaxis is recommended to all patients undergoing transurethral resection of prostate (TURP), little data exist regarding prescribing patterns of urologists prior to this procedure. Here, we sought to determine real-world antibiotic prophylaxis prescribing patterns at a high volume Canadian institution and determine compliance rates to recommendations put forth by the American Urological Association's (AUA) Best Practice Statement (BPS) on antimicrobial prophylaxis. Methods: A retrospective chart review of 488 patients undergoing TURP was conducted. Electronic medical records were reviewed to determine antibiotics prescribed 3 hours preoperatively and 24 hours postoperatively. For patients without a catheter, compliance was defined as those receiving an antibiotic prior to TURP. In patients with an indwelling catheter, compliance was defined as those receiving antibiotics from two different classes prior to surgery. Results: Overall, a total of 30 antibiotic regimens were utilized. The most common single antibiotic regimens prescribed were ciprofloxacin (32%), cefazolin (25%) and gentamicin (3%). In those patients with indwelling Foley catheters prior to TURP, a significant increase in gentamicin, as well as combination antibiotic regimens, was noted. The compliance rate with the AUA BPS in patients without a preoperative catheter was 81%, while the compliance rate for patients with an indwelling catheter prior to TURP was 37%. Interpretation: Collectively, our results demonstrate that prescribing patterns vary significantly prior to TURP, with compliance to AUA BPS being lower than anticipated. Overall, these results support educational efforts in this area, and the development of Canadian recommendations to improve uptake by practicing urologists.

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“…Other studies indicate that co-trimoxazole, cephalexin, mecillinam, and cefoxitin will all reduce bacteriuria after TURP [29,43,44].…”

Section: Transurethral Surgerymentioning

confidence: 98%

Antimicrobial prophylaxis in urology and transplantation

Chisholm

1982

World j. surg.

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The main source of infection in urological practice is from the presence of an indwelling catheter. The risk of catheteracquired infection is determined by the duration of catheterization, the adequacy of free drainage, and the efficiency of the closed drainage system. Many catheter‐acquired infections are due to multiresistant strains ofEscherichia coli, Klebsiella sp.,Pseudomonas aeruginosa, Proteus sp., and Providentia sp. Antibiotic prophylaxis has no place in the prevention of catheter‐acquired infections, and prophylaxis should be achieved by scrupulous aseptic technique and reducing the duration of drainage. The problems of catheters in the paraplegic are discussed. Septicemia and endotoxemia are the most feared complications of cystoscopy and retropubic prostatectomy if the urinary tract is infected and of transrectal biopsy of the prostate. For this reason, antibiotic cover is generally advised for these procedures. Sepsis is still a major cause of death in patients who have received a renal transplant. These infections are not only bacterial, but viral, protozoal, and fungal. The severity and frequency of these infections have been reduced by less aggressive immunosuppression. There is probably a place for perioperative antibiotic cover, but long‐term antibiotics should be avoided.

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Prostatectomy and prophylaxis

Cited by 8 publications

References 0 publications

Antibiotic prophylaxis for transurethral urological surgeries: Systematic review

Antibiotic prophylaxis for transurethral urological surgeries: Systematic review

Assessment of Antibiotic Prophylaxis Prescribing Patterns for TURP: A Need for Canadian Guidelines?

Antimicrobial prophylaxis in urology and transplantation

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