Journal List > Korean J Urogenit Tract Infect Inflamm > v.9(2) > 1059938

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

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.

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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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