Antibiotic prophylaxis for transurethral urological surgeries: Systematic review

Basim S Alsaywid, Grahame H H Smith, Basim S Alsaywid, Grahame H H Smith

Abstract

The use of antibiotic prophylaxis to prevent urinary tract infection and bacteremia (sepsis) following endoscopic urologic procedures is a controversial topic. Evidence in the literature revealed that urological instrumentation is associated with increased incidence of urinary tract infection and bacteremia. The aim of this review is to evaluate the effectiveness of antibiotic prophylaxis in reducing the risk of urinary tract infection in patients who had transurethral urological surgeries. We have selected all RCTs of adult population who underwent all different types of transurethral urological surgery, including cystoscopy, transurethral resection of prostate and transurethral resection of bladder tumor, and received prophylactic antibiotics or placebo/no treatment. At first, more than 3000 references were identified and reviewed; of which 42 studies with a total of 7496 patients were included in the final analysis. All those trials were analyzing antibiotic prophylaxis versus placebo/no treatment, and they were significantly favoring antibiotic use in reducing all outcomes, including bacteriuria (RR 0.36, 95% CI 0.29 to 0.46, P < 0.0001) with moderate heterogeneity detected (I(2) 48%), symptomatic UTI (RR 0.38, 95% CI 0.28 to 0.51, P < 0.0001) with no significant heterogeneity was detected (I(2)= 17%), bacteremia (RR 0.43, 95% CI 0.23 to 0.82, P < 0.0001) with no noted heterogeneity (I(2) = 0%), and fever ≥38.5 Celsius (RR 0.41, 95% CI 0.23 to 0.73, P = 0.003); also, there was no noted heterogeneity (I(2) = 0%). However, using antibiotic prophylaxis did not reduce the incidence of low grade temperature (RR 0.82, 95% CI 0.61 to 1.11, P = 0.20) or in moderate grade temperature (RR 1.03, 95% CI 0.71 to 1.48, P = 0.89). Antibiotic prophylaxis appears to be an effective intervention in preventing urinary tract infections and its sequels following transurethral urological surgeries in patients with preoperative sterile urine.

Keywords: Antibiotic prophylaxis; bacteremia; endourology; urinary tract infection.

Conflict of interest statement

Conflict of Interest: None.

Figures

Figure 1
Figure 1
Flow-chart of screening process
Figure 2
Figure 2
Funnel plots for included trials
Figure 3
Figure 3
Forest plot of comparison: Antibiotic prophylaxis versus placebo/no treatment, outcome: 1.1 bacteriuria
Figure 4
Figure 4
Forest plot of comparison: Antibiotic prophylaxis versus control/placebo, outcome: 1.2 bacteriuria according to the urological procedure performed
Figure 5
Figure 5
Forest plot of comparison: Antibiotic prophylaxis versus control/placebo, outcome: 1.3 bacteriuria according antibiotic course (single dose, ≤3 days course, or >3 days course)
Figure 6
Figure 6
Forest plot of comparison: Antibiotic prophylaxis versus control/placebo, outcome: 2 symptomatic urinary tract infection
Figure 7
Figure 7
Forest plot comparison: Antibiotic prophylaxis versus control/placebo, outcome: 3 bacteremia
Figure 8
Figure 8
Forest plot of comparison: Antibiotic prophylaxis versus control/placebo, outcome: 4 fever, divided according to temperature grades

References

    1. Reuter MA, Reuter HJ. The development of the cystoscope. J Urol. 1998;159:638–40.
    1. Childs SJ. Appropriate surgical prophylaxis in transurethral genitourinary surgery and potential reduction in nosocomial infections. Urology. 1986;27:415–20.
    1. Goldwasser B, Bogokowsky B, Nativ O, Sidi AA, Jonas P, Many M. Urinary infections following transurethral resection of bladder tumors: Rate and source. J Urol. 1983;129:1123–4.
    1. Qiang W, Jianchen W, MacDonald R, Monga M, Wilt TJ. Antibiotic prophylaxis for transurethral prostatic resection in men with preoperative urine containing less than 100,000 bacteria per ml: A systematic review. J Urol. 2005;173:1175–81.
    1. Kunin CM. Nosocomial urinary tract infections and the indwelling catheter: What is new and what is true? Chest. 2001;120:10–2.
    1. Grabe M. Perioperative antibiotic prophylaxis in urology. Curr Opin Urol. 2001;11:81–5.
    1. Kraklau DM, Wolf JS., Jr Review of antibiotic prophylaxis recommendations for office-based urologic procedures. Tech Urol. 1999;5:123–8.
    1. Rané A, Cahill D, Saleemi A, Montgomery B, Palfrey E. The issue of prophylactic antibiotics prior to flexible cystoscopy. Eur Urol. 2001;39:212–4.
    1. Puppo P, Ricciotti G, Bozzo W, Introini C. Primary endoscopic treatment of ureteric calculi. A review of 378 cases. Eur Urol. 1999;36:48–52.
    1. Rao PN, Dube DA, Weightman NC, Oppenheim BA, Morris J. Prediction of septicemia following endourological manipulation for stones in the upper urinary tract. J Urol. 1991;146:955–60.
    1. Hendrikx AJ, Strijbos WE, de Knijff DW, Kums JJ, Doesburg WH, Lemmens WA. Treatment for extended-mid and distal ureteral stones: SWL or ureteroscopy?Results of a multicenter study. J Endourol. 1999;13:727–33.
    1. Dall’Era MA, Walsh TJ, Krieger JN. Infectious complications of urologic surgery. In: Loughlin Kevin R., editor. Complications of Urologic Surgery and Practice: Diagnosis, Prevention and Management. New York: Informa; 2007. pp. 1–16.
    1. Raz R, Almog D, Elhanan G, Shental J. The use of ceftriaxone in the prevention of urinary tract infection in patients undergoing transurethral resection of the prostate (TUR-P) Infection. 1994;22:347–9.
    1. Morris MJ, Golovsky D, Guinness MD, Maher PO. The value of prophylactic antibiotics in transurethral prostatic resection: A controlled trial, with observations on the origin of postoperative infection. Br J Urol. 1976;48:479–84.
    1. Symes JM, Hardy DC, Sutherns K, Blandy JP. Factors reducing the rate of infection after trans-urethral surgery. Br J Urol. 1972;44:582–6.
    1. Berry A, Barratt A. Prophylactic antibiotic use in transurethral prostatic resection: A meta-analysis. J Urol. 2002;167:571–7.
    1. Mebust WK. Prophylactic antibiotics in transurethral surgery. J Urol. 1993;150:1734–5.
    1. Chodak G, Plaut ME. Systemic antibiotics for prophylaxis in urologic surgery: A critical review. J Urol. 1979;121:695–9.
    1. Appell RA, Flynn JT, Paris AM, Blandy JP. Occult bacterial colonization of bladder tumors. J Urol. 1980;124:345–6.
    1. Charton M, Vallencien G, Veillon B, Brisset JM. Antibiotic prophylaxis of urinary tract infection after transurethral resection of the prostate: A randomized study. J Urol. 1987;138:87–9.
    1. Amin M. Antibacterial prophylaxis in Urology: A review. Am J Med. 1992;92:114S–117S.
    1. Slavis SA, Miller JB, Golji H, Dunshee CJ. Comparison of single-dose antibiotic prophylaxis in uncomplicated transurethral resection of the prostate. J Urol. 1992;147:1303–6.
    1. Chen RN, Kavoussi LR. Therapeutic ureteroscopy. In: Marshall FF, editor. Textbook of Operative Urology. Philadelphia: WB Saunders; 1996. pp. 40–7.
    1. Moore RG, Marshall FF. Endoscopic treatment of urethral strictures and urethral obliteration. In: Marshall FF, editor. Textbook of Operative Urology. Philadelphia: WB Saunders; 1996. pp. 99–106.
    1. ElMalik EM, Ibrahim AI, Gahli AM, Saad MS, Bahar YM. Risk factors in prostatectomy bleeding: Preoperative urinary infection is the only reversible factor. Eur Urol. 2000;37:199–204.
    1. Kanamaru S, Terai A, Ishitoya S, Kunishima Y, Nishiyama H, Segawa T, et al. Assessment of a protocol for prophylactic antibiotics to prevent perioperative infection in urological surgery: A preliminary study. Int J Urol. 2004;11:355–63.
    1. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0. The Cochrane Collaboration. 2008. [updated February 2008]. Available from: .
    1. Bannister G, Arkell DG, Menday AP. Prostatectomy and prophylaxis. J Antimicrob Chemother. 1981;7:209–10.
    1. Botto H, Richard F, Mathieu F, Perreau AM, Camey M. Short-term prophylaxis with cefotaxime in prostatic surgery. J Antimicrob Chemother. 1984;14:231–5.
    1. Cam K, Kayikci A, Erol A. Prospective evaluation of the efficacy of antibiotic prophylaxis before cystoscopy. Indian J Urol. 2009;25:203–6.
    1. Charton M, Vallancien G, Veillon B, Brisset JM. Antibiotic prophylaxis of urinary tract infection after transurethral resection of the prostate: A randomized study. J Urol. 1987;138:87–9.
    1. Childs SJ, Wells WG, Mirelman S. Antibiotic prophylaxis for genitourinary surgery in community hospitals. J Urol. 1983;130:305–8.
    1. Conn IG, Moffat LE. Short-term cephradine prophylaxis in elective transurethral prostatectomy. J Hosp Infect. 1988;11:373–5.
    1. Costa FJ. Lomefloxacin prophylaxis in visual laser ablation of the prostate. Urology. 1994;44:933–6.
    1. Desai KM, Abrams PH, White LO. A double-blind comparative trial of short-term orally administered enoxacin in the prevention of urinary infection after elective transurethral prostatectomy: A clinical and pharmacokinetic study. J Urol. 1988;139:1232–4.
    1. Dørflinger T, Madsen PO. Antibiotic prophylaxis in transurethral surgery. Urology. 1984;24:643–6.
    1. Fair WR. Perioperative use of carbenicillin in transurethral resection of prostate. Urology. 1986;27:15–8.
    1. Falkiner FR, Ma PT, Murphy DM, Cafferkey MT, Gillespie WA. Antimicrobial agents for the prevention of urinary tract infection in transurethral surgery. J Urol. 1983;129:766–8.
    1. Ferrie BG, Scott R. Prophylactic cefuroxime in transurethral resection. Urol Res. 1984;12:279–81.
    1. Finkelstein LH, Arsht DB, Manfrey SJ, Childs S. Ceftriaxone in the prevention of postoperative infection in patients undergoing transurethral resection of the prostate. Am J Surg. 1984;148:19–21.
    1. Gasser TC, Wisard M, Frei R. Oral fleroxacin prophylaxis in transurethral surgery. J Urol. 1996;156:146–8.
    1. Gibbons RP, Stark RA, Correa RJ, Jr, Cummings KB, Mason JT. The prophylactic use–or misuse–of antibiotics in transurethral prostatectomy. J Urol. 1978;119:381–3.
    1. Higgins PM. Value of porphylactic antibacterial therapy in instrumentation of urinary tract. Br Med J. 1966;1:26–9.
    1. Holl WH, Rous SN. Is antibiotic prophylaxis worthwhile in patients with transurethral resection of prostate? Urology. 1982;19:43–6.
    1. Houle AM, Mokhless I, Sarto N, Elhilali MM. Perioperative antibiotic prophylaxis for transurethral resection of the prostate: Is it justifiable? J Urol. 1989;142:317–9.
    1. Ibrahim AI, Rashid M. Comparison of local povidone-iodine antisepsis with parenteral antibacterial prophylaxis for prevention of infective complications of TURP: A prospective randomized controlled study. Eur Urol. 2002;41:250–6.
    1. Johnson MI, Merrilees D, Robson WA, Lennon T, Masters J, Orr KE, et al. Oral ciprofloxacin or trimethoprim reduces bacteriuria after flexible cystoscopy. BJU Int. 2007;100:826–9.
    1. Kjaergaard B, Petersen E, Lauridsen KG, Petersen AS. Prophylactic one-dose treatment with clindamycin and gentamicin in transurethral prostatic resection. A double-blind placebo controlled study. Scand J Urol Nephrol. 1989;23:109–13.
    1. MacDermott JP, Ewing RE, Somerville JF, Gray BK. Cephradine Prophylaxis in Transurethral Procedures for carcinoma of the Bladder. Br J Urol. 1988;62:136–9.
    1. Mendoza GB, Jr, Gerwig WH, Jr, Stackhouse KL, Easley GW. Prophylactic use of antibacterial drugs following cystoscopy: A Double-blind controlled study of demeclocycline hydrochloride and sulfamethoxypyridazine. J Urol. 1971;106:682–4.
    1. Murdoch DA, Badenoch DF, Gatchalian ER. Oral ciproflocacin as prophylaxis in transurethral resection of the prostate. Br J Urol. 1987;60:153–6.
    1. Nielsen OS, Maigaard S, Frimodt-Møller N, Madsen PO. Prophylactic antibiotics in transurethral prostatectomy. J Urol. 1981;126:60–2.
    1. Prokocimer P, Quazza M, Gibert C, Lemoine JE, Joly ML, Dureuil B, et al. Short-term prophylactic antibiotics in patients undergoing prostatectomy: Report of a double-blind randomized trial with 2 intravenous doses of cefotaxime. J Urol. 1986;135:60–4.
    1. Qvist N, Christiansen HM, Ehlers D. Prophylactic antibiotics in transurethral prostatectomy. Urol Res. 1984;12:275–7.
    1. Rodrigues P, Hering F, Meller A, Campagnari JC, D’Império M. A randomized and prospective study on the value of antibiotic prophylaxis administration in transurethral resection of the prostate. Sao Paulo Med J. 2004;122:4–7.
    1. Scholz M, Luftenegger W, Harmuth H, Wolf D, Höltl W. Single-dose antibiotic prophylaxis in transurethral resection of the prostate: A prospective randomized trial. Br J Urol. 1998;81:827–9.
    1. Shah PJ, Williams G, Chaudary M. Short-term antibiotic prophylaxis and prostatectomy. Br J Urol. 1981;53:339–43.
    1. Shearman CP, Silverman SH, Johnson M, Young CH, Farrar DJ, Keighley MR, et al. Single dose, oral antibiotic cover for transurethral prostatectomy. Br J Urol. 1988;62:434–8.
    1. Slavis SA, Miller JB, Golji H, Dunshee CJ. Comparison of single-dose antibiotic prophylaxis in uncomplicated transurethral resection of the prostate. J Urol. 1992;147:1303–6.
    1. Stricker PD, Grant AB. Relative value of antibiotics and catheter care in the prevention of urinary tract infection after transurethral prostatic resection. Br J Urol. 1988;61:494–7.
    1. Taylor EW, Lindsay G. Antibiotic prophylaxis in transurethral resection of the prostate with reference to the influence of preoperative catheterization. J Hosp Infect. 1988;12:75–83.
    1. Viitanen J, Talja M, Jussila E, Nurmi M, Permi J, Puolakka VM, et al. Randomized controlled study of chemoprophylaxis in transurethral prostatectomy. J Urol. 1993;150:1715–7.
    1. Wagenlehner FM, Wagenlehner C, Schinzel S, Naber KG Working Group “Urological Infections” of German Society of Urology. Prospective, randomized, multicentric, open, comparative study on the efficacy of a prophylactic single dose of 500 mg levofloxacin versus 1920 mg trimethoprim/sulfamethoxazole versus a control group in patients undergoing TUR of the prostate. Eur Urol. 2005;47:549–56.
    1. Weiss J, Wein A, Jacobs J, Hanno P. Use of nitrofurantoin macrocrystals after transurethral prostatectomy. J Urol. 1983;130:479–80.
    1. Williams M, Hole DJ, Murdoch RW, Ogden AC, Hargreave TB. 48-hour cephradine and post-prostatectomy bacteriuria. Br J Urol. 1980;52:311–5.
    1. Wilson L, Ryan J, Thelning C, Masters J, Tuckey J. Is antibiotic prophylaxis required for flexible cystoscopy?A truncated randomized double-blind controlled trial. J Endourol. 2005;19:1006–8.
    1. Yokoyama M, Fujii Y, Yoshida S, et al. Discarding antimicrobial prophylaxis for transurethral resection of bladder tumor: A feasibility study. Int J Urol. 2009;16:61–3.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться