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Kim, Cho, Baik, Lim, Nho, and Kim: Antimicrobial Prophylaxis in Transurethral Enucleation and Resection of the Prostate: A Comparison of 1-Day Treatment and More than 2-Day Treatment
Original Article

Korean J Urogenit Tract Infect Inflamm 2014;9(2):104-110.

Published online: 17 October 2014

DOI: https://doi.org/10.14777/kjutii.2014.9.2.104

Antimicrobial Prophylaxis in Transurethral Enucleation and Resection of the Prostate: A Comparison of 1-Day Treatment and More than 2-Day Treatment

Min Seok Kim, Won Jin Cho, Seung Baik, Dong Hoon Lim, Joon Nho, Chul Sung Kim

Department of Urology, College of Medicine, Chosun University, Gwangju, Korea

Correspondence to: Chul Sung Kim Department of Urology, Chosun University Hospital, 365, Pilmun-daero, Dong-gu, Gwangju 501-717, Korea Tel: +82-62-220-3210, Fax: +82-62-236-3211 E-mail: cskim@chosun.ac.kr

Received 12 October 201416 October 2014       Accepted 22 October 2014

Copyright © 2014 Korean Association of Urogenital Tract Infection and Inflammation

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the efficacy of 1-day treatment of antimicrobial prophylaxis by analysis of the incidence and risk factors for postoperative infectious complications such as bacteriuria and urinary tract infection in the transurethral enucleation and resection of the prostate (TUERP).

Materials and Methods

A retrospective review of 78 patients who underwent TUERP was performed. Of 78 patients, 32 patients received antibiotics less than 1 day (group A). The other 46 patients received antibiotics for more than 2 days (group B). All patients had urinalysis and urine culture preoperatively, on the day of removal, at 1-2 weeks and 3-4 weeks after discharge. The incidence and the risk factors for postoperative infectious complication were investigated.

Results

The incidence of infectious complications after TUERP was not statistically significant between group A and group B (18.8% vs. 15.2%, p=0.680). Multivariate analysis documented only two independent risk factors of postoperative infectious complications: preoperative catheterization (OR, 4.189; 95% CI, 1.071-16.382; p=0.040) and diabetes mellitus (DM) (OR, 5.589; 95% CI, 1.469-21.256; p=0.012). Comparative analysis performed in subgroups with two risk factors also showed no difference in the incidence of infectious complication regardless of antibiotic duration.

Conclusions

No significant difference in the incidence of postoperative infectious complications was observed between two groups. Therefore, it seems reasonable to prescribe prophylactic antibiotics less than 1 day for reducing postoperative infectious complications after TUERP. Preoperative urethral catheterization and DM were identified as significant risk factors for postoperative infectious complications and preventive management directed against the risk factors preoperatively is recommended.

Keywords: Antibiotic, Transurethral resection of prostate, Urinary tract infections, Risk factors

REFERENCES

1. Alsaywid BS, Smith GH. Antibiotic prophylaxis for transurethral urological surgeries: Systematic review. Urol Ann. 2013; 5:61–74.
crossref
2. Berry A, Barratt A. Prophylactic antibiotic use in transurethral prostatic resection: a metaanalysis. J Urol. 2002; 167:571–7.
3. 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.
crossref
4. Kim CS. Antimicrobial prophylaxis for urologic surgery. Korean J Urogenit Tract Infect Inflamm. 2009; 4:20–36.
5. Hwang EC, Yu SH, Kim JB, Jung SI, Kang TW, Kwon DD, et al. Risk factors of infectious complications after transurethral prostate surgery in patients with preoperative sterile urine. Korean J Urogenit Tract Infect Inflamm. 2013; 8:27–31.
crossref
6. Kim DH, Bae SR, Choi WS, Park HK, Paick SH, Kim HG, et al. The real practice of antibiotic prophylaxis for prostate biopsy in Korea where the prevalence of quinolone-resistant Escherichia coli is high. Korean J Urol. 2014; 55:593–8.
7. Jung SI. Antimicrobial prophylaxis for prostatic surgery. Korean J Urogenit Tract Infect Inflamm. 2014; 9:14–20.
crossref
8. Bootsma AM, Laguna Pes MP, Geerlings SE, Goossens A. Antibiotic prophylaxis in urologic procedures: a systematic review. Eur Urol. 2008; 54:1270–86.
crossref
9. Mossanen M, Calvert JK, Holt SK, James AC, Wright JL, Harper JD, et al. Overuse of antimicrobial prophylaxis in community practice urology. J Urol 2014. [Epub ahead of print].
10. Cek M, Tandogdu Z, Naber K, Tenke P, Wagenlehner F, van Oostrum E, et al. Global Prevalence Study of Infections in Urology Investigators. Antibiotic prophylaxis in urology departments, 2005-2010. Eur Urol. 2013; 63:386–94.
11. Calvert JK, Holt SK, Mossanen M, James AC, Wright JL, Porter MP, et al. Use and outcomes of extended antibiotic prophylaxis in urological cancer surgery. J Urol. 2014; 192:425–9.
crossref
12. Health Insurance Review & Assessment Service. Antimicrobial prophylaxis for surgery: presentation to Health-Care Institution. Seoul: Health Insurance Review & Assessment Service, 2013 Nov.
13. Zhao Z, Zeng G, Zhong W, Mai Z, Zeng S, Tao X. A prospective, randomised trial comparing plasmakinetic enucleation to standard transurethral resection of the prostate for symptomatic benign prostatic hyperplasia: three-year followup results. Eur Urol. 2010; 58:752–8.
crossref
14. Grabe M, Botto H, Cek M, Tenke P, Wagenlehner FM, Naber KG, et al. Preoperative assessment of the patient and risk factors for infectious complications and tentative classification of surgical field contamination of urological procedures. World J Urol. 2012; 30:39–50.
crossref
15. 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/sulfametho-xazole versus a control group in patients undergoing TUR of the prostate. Eur Urol. 2005; 47:549–56.
16. Girou E, Rioux C, Brun-Buisson C, Lobel B. Infection Committee of the French Association of Urology. The postoperative bacteriuria score: a new way to predict nosocomial infection after prostate surgery. Infect Control Hosp Epidemiol. 2006; 27:847–54.
crossref
17. Colau A, Lucet JC, Rufat P, Botto H, Benoit G, Jardin A. Incidence and risk factors of bacteriuria after transurethral resection of the prostate. Eur Urol. 2001; 39:272–6.
crossref
18. Huang X, Shi HB, Wang XH, Zhang XJ, Chen B, Men XW, et al. Bacteriuria after bipolar transurethral resection of the prostate: risk factors and correlation with leukocyturia. Urology. 2011; 77:1183–7.
crossref
19. El Basri A, Petrolekas A, Cariou G, Doublet JD, Hoznek A, Bruyere F. Clinical significance of routine urinary bacterial culture after transurethral surgery: results of a prospective multicenter study. Urology. 2012; 79:564–9.
crossref
20. Wolf JS Jr, Bennett CJ, Dmochowski RR, Hollenbeck BK, Pearle MS, Schaeffer AJ. Urologic Surgery Antimicrobial Prophylaxis Best Practice Policy Panel. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol. 2008; 179:1379–90.
crossref
21. Grabe M, Bartoletti R, Bjerklund-Johansen TE, Cek M, Pickard RS, Tenke P, et al. Guidelines on urological infections. Arnhem: EAU Guidelines Office. 2014. 70–92.
22. Matsumoto T, Kiyota H, Matsukawa M, Yasuda M, Arakawa S, Monden K. Japanese Society of UTI Cooperative Study Group (Chairman; Tetsuro Matsumoto). Japanese guidelines for prevention of perioperative infections in urological field. Int J Urol. 2007; 14:890–909.
crossref
23. Agarwal RK, Gould CV, Kuntz G, Pegues DA, Umscheid CA. Health care Infection Control Practices Advisory Committee. Guideline for prevention of catheter-associated urinary tract infections 2009 [Internet]. Atlanta (GA): Centers for Disease control and Prevention;2009. [cited 2013 Feb 14]. Available from:. http://stacks.cdc.gov/view/cdc/11561/.
24. Wald HL, Ma A, Bratzler DW, Kramer AM. Indwelling urinary catheter use in the postoperative period: analysis of the national surgical infection prevention project data. Arch Surg. 2008; 143:551–7.
25. Chen JS, Chang CH, Yang WH, Kao YH. Acute urinary retention increases the risk of complications after transurethral resection of the prostate: a population-based study. BJU Int. 2012; 110:E896–901.
crossref
26. Geerlings SE. Urinary tract infections in patients with diabetes mellitus: epidemiology, pathogenesis and treatment. Int J Antimicrob Agents. 2008; 31(Suppl 1):S54–7.
crossref
27. Ambiru S, Kato A, Kimura F, Shimizu H, Yoshidome H, Otsuka M, et al. Poor postoperative blood glucose control increases surgical site infections after surgery for hepato-biliary-pancreatic cancer: a prospective study in a high-volume institute in Japan. J Hosp Infect. 2008; 68:230–3.
crossref
28. Vilar-Compte D, Alvarez de Iturbe I, Martin-Onraet A, Perez-Amador M, Sanchez-Hernandez C, Volkow P. Hyperglycemia as a risk factor for surgical site infections in patients undergoing mastectomy. Am J Infect Control. 2008; 36:192–8.
crossref

Table 1.
Comparison of baseline clinical characteristics between the subgroups separated based on duration of antimicrobial prophylaxis
Characteristic Group A (n=32) Group B (n=46) p-value
Age (y) 72.3±6.8 74.9±5.3 0.065a
Age ≤70 (y) 11 (34.4) 10 (21.7) 0.216b
Preoperative pyuria 10 (31.3) 18 (39.1) 0.475b
Bladder stone 7 (21.9) 11 (23.9) 0.834b
Postoperative UTI 6 (18.8) 7 (15.2) 0.680b
Acute urinary retention 11 (34.4) 17 (37.0) 0.815b
Preoperative catheterization 11 (34.4) 17 (37.0) 0.815b
Diabetes mellitus 9 (28.1) 11 (23.9) 0.675b
Duration of postop catheterization (d) 2.7±1.2 2.7±1.6 0.946a
Duration of postop catheterization ≤3 (d) 27 (84.4) 40 (87.0) 0.747b
Operating time (min) 97.5±25.6 97.9±24.4 0.946a
Operating time ＜90 (min) 13 (40.6) 21 (45.7) 0.660b
Resected weight (g) 35.94±16.83 33.78±18.77 0.605a
Resected weight ＞30 (g) 16 (50) 24 (52.2) 0.850b

Values are presented as mean±standard deviation or number (%). UTI: urinary tract infection, postop: postoperative.

a :Student t-test,

b :chi-square test.

Table 2.
Univariate analysis of potential risk factors for the postoperative infectious complication
Clinical parameter OR (95% CI) p-value
Duration of AMP (≤1 vs. ≥2, d) 1.286 (0.388-4.260) 0.681
Age (y) 0.979 (0.887-1.082) 0.681
Age ≥70 (y) 0.797 (0.217-2.928) 0.732
Preoperative pyuria 5.447 (1.494-19.857) 0.010
Bladder stone 0.557 (0.111-2.782) 0.476
Preoperative catheterization 5.447 (1.494-19.857) 0.010
Diabetes mellitus 7.067 (1.963-25.443) 0.003
Duration of postop catheterization (d) 1.117 (0.772-1.618) 0.556
Duration of postop catheterization ≥4 (d) 1.131 (0.214-5.967) 0.884
Operating time (min) 1.015 (0.990-1.042) 0.248
Operating time >90 (min) 3.039 (0.765-12.068) 0.114
Resected weight (g) 0.990 (0.956-1.025) 0.567
Resected weight >30 (g) 0.782 (0.237-2.580) 0.686

OR: odds ratio, CI: confidence interval, AMP: antimicrobal prophylaxis, postop: postoperative.

Table 3.
Multivariate regression analysis of identifying risk factors for the postoperative infectious complications
Clinical parameter OR (95% CI) p-value
Preoperative catheterization 4.189 (1.071-16.382) 0.040
Diabetes mellitus 5.589 (1.469-21.256) 0.012

OR: odds ratio, CI: confidence interval.

Table 4.
Subgroup comparative analyses of the postoperative infectious complication among the patients having risk factors
  Group A Group B p-value∗
Preoperative pyuria 40.0% (4/10) 27.8% (5/18) 0.677
Postoperative catheterization 36.4% (4/11) 29.4% (5/17) 0.700
Diabetes mellitus 33.3% (3/9) 45.5% (5/11) 0.670

∗ Fisher's exact test.

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