Cefotaxime for Prevention of Infectious Complications in Bacteriuric Men Undergoing Transurethral Prostatic Resection

Abstract

Forty-two men with urinary tract infection and benign prostatic hyperplasia were randomized into two groups before transurethral resection. One group (22 patients) received Claforan (cefotaxime) peroperatively and thereafter daily for five days. In the other group (20 patients), Hiprex (methenamine hippurate) was given daily from the day before the operation, for a total of six days. All the bacterial isolates were sensitive to cefotaxime. The efficacy of the medication was clinically and bacteriologically evaluated. Postoperative temperature elevation (greater than 38 degrees C) occurred in one of the 22 patients in the cefotaxime group, and in nine of the 20 in the methenamine hippurate group (p less than 0.05). None of the former group, but two patients in the latter, had septicemia. The difference was not statistically significant. The response to treatment was satisfactory in 13 of the 22 patients in the cefotaxime group, but in only one of the 20 treated with methenamine hippurate (p less than 0.005). Antibiotic treatment is recommended for bacteriuric patients undergoing transurethral prostatic resection.

Is short course of antimicrobial therapy for asymptomatic bacteriuria before urologic surgical procedures sufficient?

“…Group A (n = 39) Group B (n = 30) Transurethral prostatic resection (TUR-P) 8 Generally treatment of asymptomatic bacteriuria is recommended for any urological procedure in which mucosal bleeding is encountered [2,5,13]. In our study, along with TUR-P, other procedures were included.…”

“…Duration of postoperative antibiotic treatment has been reported to range from 24 hours to 10 days [5][6][7]13,17,[20][21][22]. A common recommendation in these studies is to continue antimicrobial therapy at least until removal of indwelling catheters.…”

“…Screening and treatment of asymptomatic bacteriuria in pregnant women and before some urological procedures has been recommended in the guidelines of the Infectious Diseases Society of America (IDSA) [2]. Preoperative bacteriuria was shown to increase the severe infectious complications such as bacteremia, septicemia, and upper urinary tract infection, especially following various urological interventions [3][4][5][6]. Accordingly, many studies have shown that appropriate antimicrobial treatment preoperatively and postoperatively could decrease the occurrence of these severe infectious complications [5,7,8].…”

“…Preoperative bacteriuria was shown to increase the severe infectious complications such as bacteremia, septicemia, and upper urinary tract infection, especially following various urological interventions [3][4][5][6]. Accordingly, many studies have shown that appropriate antimicrobial treatment preoperatively and postoperatively could decrease the occurrence of these severe infectious complications [5,7,8]. However, the time interval that should be adhered to between antimicrobial therapy and the start of the surgical procedure as well as the length of the postoperative treatment is not clearly defined [1].…”

Asymptomatic bacteriuria: review and discussion of the IDSA guidelines

“…Prospective, randomized clinical trials report that treatment of asymptomatic bacteriuria prior to transurethral resection of the prostate (TURP) decreases postprocedure bacteraemia and sepsis [29][30][31][32]. The antimicrobial regimens evaluated in these studies varied in antimicrobial selection, time of screening culture, time of antimicrobial initiation relative to start of the procedure, and duration of antibiotic therapy.…”