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

Abstract

Introduction: Duration of treatment of asymptomatic bacteriuria for patients undergoing urologic surgical procedures is undetermined. We compared the efficacy of long-versus short-course antimicrobial treatment in patients with asymptomatic bacteriuria undergoing urologic surgical procedures. Methodology: Patients were divided into two groups according to duration of antimicrobial treatment. Group A patients received a single dose of an appropriate antibiotic, determined by antimicrobial sensitivity testing, 30 to 60 minutes before the surgical procedure. If a urinary catheter was placed postoperatively, a second dose was given following the recommended dose interval. Group B patients received antimicrobial treatment prior to surgery at least until patient urine became sterile. All patients were monitored for signs and symptoms of septicemia following surgical procedures. Results: None of the patients enrolled in the study developed infectious complications such as sepsis or upper urinary tract infection. In group A, 31 patients were treated with antimicrobials before 39 urological procedures. In group B, the mean treatment time for 28 patients before 30 urological procedures was 8.03 ± 3.86 days. There were also significant differences in length of stay and the cost of antimicrobial therapy between the groups (P < 0.0001). Isolation of an increased number of resistant microorganisms was associated with long course therapy in group B. Conclusions: Short course therapy protocol may be a practical, simple approach for antibiotic use; it decreases hospital stays, eliminates delayed procedure times, lowers the economic cost of antimicrobials and lessens the chance of superinfection with and spread of antimicrobial resistant microorganisms.

Antibiotic prophylaxis and its appropriate timing for urological surgical procedures in patients with asymptomatic bacteriuria: A systematic review

“…The literature search retrieved 14 investigations, with nine fulfilling the inclusion criteria. Five studies analysed antibiotic prophylaxis for transrectal prostate biopsy [10] , [11] , [12] , [13] , [14] , only one study evaluated antibiotic prophylaxis for urological procedures at a general level [15] , and the remaining studies analysed antibiotic therapy for cystoscopy, transurethral prostatic resection and urethral lithotripsy [16] . The studies were published between 1998 and 2013, and were carried out in Chile, Colombia, Taiwan, India, France, Turkey, and China.…”

“…Only the study by Sayin Kutlu et al [15] conducted in Turkey between 2005 and 2008 in 59 patients scheduled for a urological procedure assessed the duration of antibiotic prophylaxis in patients with AB, indicating that there were no significant differences between single-dose therapy (30–60 min before the procedure) with an antibiotic treatment lasting 3–15 days until the urine was sterile before surgery. That study also found significant differences in the reduction of hospital stay and costs of antimicrobials in the single-dose group ( P < 0.001).…”

“…One of the most key problems of the studies included is that most of the studies (89%) did not control for the variable of AB before the intervention, whilst in others it was done in patients with negative urine cultures. Only the study of Sayin Kutlu et al [15] controlled for AB, but this study had a low sample size (31 patients in the intervention group and 28 in the comparison group) and did not control for confounding variables such as permanent vesicle catheter or immunosuppression. In addition, most of the urological procedures were insertion or change of JJ catheters.…”

A short course of antimicrobial therapy for asymptomatic bacteriuria is safe and effective before urologic procedures

“…Our study showed that a single dose or two doses of antimicrobial therapy was effective in preventing severe infectious complications such as upper UTI and septicemia following urological procedures in patients with pre-procedure ASB. We had previously come to this conclusion in a small prospective study including 31 procedures [10]. That study showed that shortcourse treatment (one or two doses) of ASB resulted in a significantly shorter length of stay and cost of antimicrobial therapy, while long term treatment was associated with subsequent isolation of a greater number of resistant microorganisms [10].…”

“…Although short-course treatment may not eradicate the microorganism from the urinary system, it can prevent bacteremia and sepsis. In our previous study, a single dose of antimicrobial was given to 31 patients 30 to 60 minutes before the surgical procedure and a second dose if a catheter was placed postoperatively, and none of the patients had no severe infectious complications [10]. We reviewed the effectiveness of single or two-dose antimicrobial treatment, and post-procedure infectious complications in a large group of patients in the current study.…”