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

Abstract

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.

Antibiotic Prophylaxis in Transurethral Resections: What Are the Criteria That Should Be Followed?

“…Also, there is no consensus regarding the use of antibiotics; Lawson et al noticed in a review of 488 patients who underwent TURP that a total of 30 antibiotic regimens were utilised. The most common single antibiotic regimens prescribed were ciprofloxacin (32%), cefazolin (25%), and gentamicin (3%) [5].…”

“…Contrary to said data, the present study only surveyed 3 diabetic patients with a postoperative positive urine culture [18]. All guidelines recommend the administration of antibiotic prophylaxis in men who will undergo TUR-P to reduce the risk of UTIs or asymptomatic bacteriuria [5,19]. Many studies are evaluating the effects of antibiotic prophylaxis on men undergoing TURP.…”

“…Data from specialty literature has suggested that surgical instrumentation is associated with a higher incidence of UTIs and possible septicaemia [2]. The incidence of UTIs after TUR-P (transurethral resection of the prostate) has varied from 6% to 60% in different studies, and when it comes to TUR-BT (transurethral resection of the bladder tumour), it has varied from 3% to 38.9% [5,6,7]. A longer duration of the intervention, disconnecting the closed urine drainage system, and a prolonged postoperative urinary catheterisation of over 3 days are risk factors associated with postoperative bacteriuria.…”

Postoperative antibiotic therapy patterns in Benign Prostatic Hyperplasia (BPH) patients

“…Patients undergoing TURP with a foley catheter in place can increase the risk of infection. The use of gentamicin in these patients shows a reasonably stable condition and reduces infection risk (Lawson, Rudzinski, Vicas & Carlson, 2013).…”

Antibiotic use prior to transurethral resection of the prostate: Are we doing what we think we are doing?

“…1 Overall, 488 patients are grouped into two distinct sets: A set with an indwelling catheter and the other with no preoperative catheter. It is shown that the compliance rate with the AUA best practice statement (BPS) (which recommended antibiotic prophylaxis in all TURP patients) is 81% in the first set of patients and 37% in the second.…”