Relative Value of Antibiotics and Catheter Care in the Prevention of Urinary Tract Infection after Transurethral Prostatic Resection

Abstract

One hundred patients were prospectively randomised into two groups to receive either a single dose of 1 g ampicillin and 80 mg gentamicin pre-operatively or no antibiotic prophylaxis. The incidence of breakage in the continuity of the closed drainage system was documented. All patients with urinary tract infection (UTI), catheterisation, clinical prostatic carcinoma, neurogenic bladder and bladder tumours were excluded. UTIs, bacteraemia and fever were noted. There were 7 late exclusions. The incidence of UTI in the control and antibiotic groups was 16 and 17% respectively. No blood cultures were positive. There were no significant differences in the incidence of fever between the two groups. A break in the closed drainage system occurred in 13 patients. Fifteen of the 93 developed UTI. A break in the closed drainage system occurred in 7 of the 15 patients (40%) with UTI. Of the 78 patients without UTI, 8 had a break (10%). This difference was highly significant. We recommend that less emphasis be placed on prophylactic antibiotics and more on avoiding breakage of the closed system in the prevention of UTI after transurethral resection of the prostate (TURP) in the low risk situation.

Incidence and Risk Factors of Bacteriuria after Transurethral Resection of the Prostate

“…The prospective nature of this study, the 1–month duration of the postoperative follow–up and the small number of patients lost to follow–up probably increased the sensitivity of determination of the incidence of PBU. The incidence of PBU detected on removal of the catheter in our study (8%) was similar to that reported in the literature [2, 8]. In contrast, the incidence of PBU between postoperative days 7 and 10 (14%) was higher than usually reported during this period [1, 2, 3, 6, 8].…”

“…Disconnection of the closed drainage system constitutes a major risk factor for bacteriuria in medical patients with short–term catheterization [20]. Several studies have demonstrated a direct correlation between disconnection of the system and bacteriuria [8]. Our study shows, for the first time, that disconnection of the closed urine drainage system is the most important risk factor for PBU after TURP.…”

“…Postoperative bacteriuria (PBU) complicates 1–17% of transurethral resections of the prostate (TURP) [1, 2, 3, 4, 5, 6, 7, 8, 9]. This procedure corresponds to Altemeier class II (contaminated clean surgery with opening of the urinary tract with sterile preoperative urine) [10].…”

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

“…6,[18][19][20][21][22][23][24][25] This is further supported by a RCT demonstrating equivalent outcomes with the use of levofloxacin versus TMP-SMX as antibiotic prophylaxis for TURP. 2 As such, the wide variety of antibiotic regimens used by urologists at our institution is understandable as no single agent stands out as superior with respect to efficacy (Fig.…”

“…4 Clinical efficacy was shown for antibiotic classes including fluoroquionolones, third generation cephalosporins, aminoglycosides and trimethroprim-sulfamethoxazole (TMP-SMX). [18][19][20][21][22][23][24][25] Based on the available evidence, the 2008 American Urology Association (AUA) Best Practice Statements (BPS) on Urologic Surgery Antimicrobial Prophylaxis recommends use of prophylactic antibiotics for all patients undergoing TURP. 1 The recommended first-line agents are fluoroquinolones or TMP-SMX, with alternatives including aminoglycosides alone or with ampicillin, cephalosporins or amoxicillin/clavulanate <24 hours prior to TURP.…”