Discarding antimicrobial prophylaxis for transurethral resection of bladder tumor: A feasibility study

Abstract

Objectives:To evaluate the feasibility of discarding antimicrobial prophylaxis (AMP) for transurethral resection of bladder tumor (TURBT). Methods: One-hundred and sixty-two patients undergoing TURBT, with no risk factors for infectious complications were included in this prospective study between April 2006 and April 2008. Forty-four patients received single oral dose of 200 mg levofloxacin for AMP (LVFX group), and the remaining 118 received no AMP (no AMP group). Rates of postoperative infectious complications were compared between the two groups. Results: There was no significant difference between the two groups in terms of baseline characteristics, including age, sex, history of TURBT, number of tumors, duration of operation and days of catheterization. Symptomatic urinary tract infections (UTIs) occurred in four patients (3.4%) in the no AMP group and one patient (2.3%) in the LVFX group (P = 0.61). All patients having UTIs were men, and were successfully treated by immediate administration of antibiotics. No patients developed extra-urinary tract infections. Conclusions: Based on our findings, AMP for TURBT in patients with no risk factors for infectious complications is not necessary. The use of antibiotics might be deferred until postoperative infections develop.

Antibiotic prophylaxis for transurethral urological surgeries: Systematic review

“…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]…”

Successful reduction of hospital-acquired methicillin-resistant Staphylococcus aureus in a urology ward: a 10-year study

“…In clean-contaminated urological surgeries, patients received AMP as follows: between January 2005 and September 2005: tazobactam sodium/piperacillin sodium (TAZ/PIPC) intravenously immediately before the surgery and for 3 days afterwards; between October 2005 and September 2006: TAZ/PIPC once immediately before the surgery; after October 2006: LVFX orally once immediately before the surgery [12,13]. In the transurethral resection of bladder tumors, patients received AMP as follows: between April and September 2006: LVFX orally once immediately before the surgery; after October 2006: no AMP was administered [23]. In contaminated urological surgeries using bowel segments, patients received cefmetazole on the operative day only, although prolonged operation and other morbidity risk factors may support the use of a prolonged regimen, which should be within three days according to the European Association of Urology guideline [21].…”

Clinical practice guidelines for antimicrobial prophylaxis in surgery

“…818,821,827,[830][831][832][833][834][835][836][837][838][839] Organisms such as S. aureus, coagulase-negative Staphylococcus species, and group A Streptococcus species are also a concern in procedures entering the skin with or without entering the urinary tract. 818,827,[830][831][832]838,840,841 There is also some concern with biofilm-forming bacteria (S. epidermidis and P. aeruginosa) in patients with prosthesis implantation. 842 Efficacy.…”

“…6 Based on bioavailability, oral antimicrobial prophylaxis should be administered 1-2 hours before surgical incision or start of the procedure. 817,[819][820][821][822]824,826,836,838,840,848,851,855 Pediatric efficacy. Limited data on antimicrobial prophylaxis are available for pediatric patients undergoing urologic procedures.…”

“…No single antimicrobial regimen appears superior for urologic procedures. A wide range of antimicrobial regimens, including cephalosporins, 658,835,836,843,[849][850][851][852][853][854][855] aminoglycosides, 856,857 piperacillintazobactam, 849,858,859 trimethoprimsulfamethoxazole, 822,838,860 trimethoprim, 839 nitrofurantoin, 861 and fluoroquinolones, 819,821,822,824,831,[835][836][837]839,840,843,848,851,[853][854][855]862,863 have been evaluated in urologic procedures. The efficacy of fluoroquinolones for antimicrobial prophylaxis in urologic surgical procedures has been well established.…”