Perioperative Antimicrobial Prophylaxis in Urology: a Multi-Center Prospective Study

Abstract

Since there are few published reports regarding the impact of urologic surgery on perioperative infections, an epidemiologic analysis was performed on data from 1,156 open or laparoscopic operations in urology collected by the 21 hospitals participating in this study between September 2002 and August 2003. Prophylactic antibiotics were administered intravenously according to our protocol designed on the basis of the invasiveness and contamination levels. The surgical site infection (SSI) rates following clean, clean-contaminated and contaminated surgery were 1.2%. 5.8% and 23.4%, respectively, while the remote infection (RI) rates were 3.5%. 7.1% and 35.9%, respectively. Methicillin-resistant Staphylococcus aureus (MRSA) was most frequently isolated from SSIs as well as RIs, whereas Enterococcus faecalis and Pseudomonas aeruginosa were more frequently discovered in RIs than in SSIs. Several risk factors for SSI and/or RI, such as older age, high ASA score, obesity, diabetes, preoperative chemotherapy, long operation time and much blood loss, were identified by univariate analysis.

Clinical practice guidelines for antimicrobial prophylaxis in surgery

“…6,826,827 Their routine use is not recommended due to their higher cost and potential to promote resistance, particularly among health-careassociated gram-negative bacilli. 8 Duration.…”

“…817,818,822,826 Preoperative UTI, particularly if recurrent, is recognized as a high-risk factor for postoperative infection, which is typically treated before procedures and is a common exclusion criterion from studies of efficacy of antimicrobial prophylaxis in urologic procedures. 817,[826][827][828] Additional urologic operation-specific risk factors include length of postoperative catheterization, 829 mode of irrigation (closed versus open), and postoperative pyuria. 821 Organisms.…”

“…E. coli is the organism most commonly isolated in patients with postoperative bacteriuria; however, other gram-negative bacilli and enterococci may also cause infection. 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.…”

A single-dose regimen for antimicrobial prophylaxis to prevent perioperative infection in urological clean and clean-contaminated surgery

“…In fact, the SSI rate following radical cystectomy with urinary diversion using bowel segments was as high as 20-30%, as shown in previous papers where the durations of AMP ranged from 1 to 4 days [10,11,17,18]. Thus, an optimal duration for AMP for procedures using bowel segments has also not been determined; the EAU guidelines suggest that continent pouches or bladder replacement may require prolonged preventive antibiotic therapy [2].…”

“…By contrast, the JUA guidelines recommended AMP for all urological surgery, except for extracorporeal shock wave lithotripsy (ESWL) [4]. Furthermore, the duration recommended for AMP in the JUA guidelines is relatively longer than that in the other guidelines, because the JUA guidelines were designed for the prevention of not only SSI, but also UTI and RI, which may occur more frequently than SSI [10,11]. Therefore, according to the JUA guidelines, the administration of antimicrobial drugs is intended to achieve therapeutic as well as preventive effects.…”