Antibiotic Prophylaxis for Genitourinary Surgery in Community Hospitals

Abstract

For 92 patients who had undergone transurethral and open urologic surgery a prospective, randomized, double-blind study was done that compared the effects of ceftriaxone, a third generation cephalosporin, to placebo. The 2 groups were similar in respect to demographic characteristics. Ceftriaxone reduced significantly the incidence of postoperative infection (p less than 0.01). Of 43 patients who received ceftriaxone 2 (5 per cent) became infected compared to 15 of 49 (30 per cent) who received placebo. Patients in the placebo group who had positive postoperative urine cultures did so approximately 2 days earlier than those in the ceftriaxone group, even though the day of catheter removal averaged about 1 1/2 days later in the ceftriaxone group. There was no correlation between the incidence of fever and infection, and there was no difference between groups with regard to postoperative bleeding, or the incidence of recatheterization or rehospitalization. Average operating time, highest temperature postoperatively and number of hospital days were approximately the same in both groups. Two patients in the placebo group had serious complications and incurred approximately $11,600 in additional expenses as a result of those complications. Of these patients 1 became septic, and 1 had urinary tract and wound infections postoperatively. These data suggest that this method of antibiotic prophylaxis will not only reduce the incidence of postoperative infection in such patients, thereby reducing morbidity, mortality and hospital costs, but also may provide an additional 1 to 2 days of protection from infection for patients who require postoperative catheterization.

Value of Clinical Decision on Antibiotic Treatment of Fever Episodes following Transurethral Resection of the Prostate

“…The incidence of both fever and bacteriuria demon strated in this study corresponds to previous findings [1,[6][7][8][9][10][11], Bacteriuria may give rise to urinary tract infection and fever, disappear spontaneously, or be quite asymptom atic [7,12], When systematic antibiotic prophylaxis is not used it may be important that patients observed without antibiotic treatment show a negative urine culture. This was the case in the present study in 90% of the patients with postoperative fever and in 95% without, indicating that the clinical evaluation had been a sufficient basis for deciding against antimicrobial therapy.…”

“…This should be compared with antibiotic prophylaxis which would result in over treatment of approximately 75% of the patients. General antimicrobial prophylaxis would probably be justified when bacteriaemia and urosepsis were avoided as de noted in some studies [1,2]. However, other investiga tions have shown that these severe complications oc curred both in patients allocated to antibiotic prophylaxis and in the controls [5,9,11], Need of blood transfusions and various catheter prob lems were associated with a significant increase in fever episodes, apparently without a simultaneous increase in urinary tract infections.…”

“…Thus significant reduction of postoperative bacteri uria, bacteriaemia, and septicaemia has been demon strated by Childs et al [1] and Allan and Kumar [2], On the other hand Ferrie and Scott [3] and Quist et al [4] found routine antibiotic prophylaxis unnecessary, since the incidence of bacteriuria and bacteriaemia was unaf fected by the prophylactic drug. The topic has been reviewed extensively by Chodak and Plaut [5], who con cluded that prophylactic antibiotics in transurethral re section of the prostate should not be recommended.…”

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

“…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.…”

“…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.…”