Antimicrobial Prophylaxis for Prostatic Surgery

Seung Il Jung

doi:10.14777/kjutii.2014.9.1.14

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Jung: Antimicrobial Prophylaxis for Prostatic Surgery

Review

Korean J Urogenit Tract Infect Inflamm 2014;9(1):14-20.

Published online: 17 April 2014

DOI: https://doi.org/10.14777/kjutii.2014.9.1.14

Antimicrobial Prophylaxis for Prostatic Surgery

Seung Il Jung

Department of Urology, Chonnam National University Medical School, Gwangju, Korea

Correspondence to: Seung Il Jung Department of Urology, Chonnam National University Hwasun Hospital, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, Hwasun 519-763, Korea Tel: +82-61-379-7749, Fax: +82-61-379-7750 E-mail: drjsi@yahoo.co.kr

Received 13 February 201410 March 2014 Accepted 11 March 2014

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

Antimicrobial prophylaxis is the periprocedural systemic administration of an antimicrobial agent intended to reduce the risk of postprocedural local and systemic infection. However, the use of antibiotics in urologic surgery has been controversial for decades. Significant progress in prostate surgery was made during the previous decade, however, controversy over antibiotic prophylaxis for prostatic surgery remains. In the context of surgical field classification, transurethral resection of the prostate and radical prostatectomy can be categorized according to a clean-contaminated operation. Therefore, in this regard, administration of prophylactic antibiotics is appropriate for prevention of postoperative infectious complications. Unfortunately, however, studies of the prophylactic effect of antimicrobial therapy with prostatic surgery have been limited. There is currently a lack of information on the risk factors for infectious complications associated with prostate surgery in Korea. In addition, the Korean National Health Insurance System recently recommended the use of current guidelines for surgical site infection focusing on gastrointestinal surgery, not urinary tract infection in patients undergoing prostate surgery without any Korean evidence. Because many urological procedures are associated with urine exposure and endourological procedures, these guidelines cannot be adapted to urologic prostatic surgery. In open or laparoscopic prostatic surgery (radical prostatectomy or prostatectomy), the urinary tract is opened during the procedure; thus, postoperative bacteriuria is probably the main source of postoperative infectious complications.

Keywords: Antibiotic prophylaxis, Prostate, Surgical wound infections, Postoperative complications

REFERENCES

1. Grabe M. Controversies in antibiotic prophylaxis in urology. Int J Antimicrob Agents. 2004; 23(Suppl 1):S17–23.

2. Bratzler DW, Houck PM. Surgical Infection Prevention Guideline Writers Workgroup. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Am J Surg. 2005; 189:395–404.

3. Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol. 1999; 20:725–30.

4. National Nosocomial Infections Surveillance (NNIS) report, data summary from October 1986-April 1996, issued May 1996. A report from the National Nosocomial Infections Surveillance (NNIS) System. Am J Infect Control. 1996; 24:380–8.

5. Kunin CM. Nosocomial urinary tract infections and the indwelling catheter: what is new and what is true? Chest. 2001; 120:10–2.

6. Grabe M. Perioperative antibiotic prophylaxis in urology. Curr Opin Urol. 2001; 11:81–5.

7. Bratzler DW, Houck PM, Richards C, Steele L, Dellinger EP, Fry DE, et al. Use of antimicrobial prophylaxis for major surgery: baseline results from the National Surgical Infection Prevention Project. Arch Surg. 2005; 140:174–82.

8. Berry A, Barratt A. Prophylactic antibiotic use in transurethral prostatic resection: a metaanalysis. J Urol. 2002; 167:571–7.

9. 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.

10. Bratzler DW, Houck PM. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis. 2004; 38:1706–15.

11. Antimicrobial prophylaxis for surgery. Treat Guidel Med Lett. 2004; 2:27–32.

12. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999; 20:250–78. quiz 79-80.

13. Page CP, Bohnen JM, Fletcher JR, McManus AT, Solomkin JS, Wittmann DH. Antimicrobial prophylaxis for surgical wounds. Guidelines for clinical care. Arch Surg. 1993; 128:79–88.

14. Antimicrobial prophylaxis in surgery. Med Lett Drugs Ther. 2001; 43:92–7.

15. Burke JF. The effective period of preventive antibiotic action in experimental incisions and dermal lesions. Surgery. 1961; 50:161–8.

16. Classen DC, Evans RS, Pestotnik SL, Horn SD, Menlove RL, Burke JP. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med. 1992; 326:281–6.

17. Bates T, Siller G, Crathern BC, Bradley SP, Zlotnik RD, Couch C, et al. Timing of prophylactic antibiotics in abdominal surgery: trial of a pre-operative versus an intra-operative first dose. Br J Surg. 1989; 76:52–6.

18. Sabbagh R, McCormack M, Péloquin F, Faucher R, Perreault JP, Perrotte P, et al. A prospective randomized trial of 1-day versus 3-day antibiotic prophylaxis for transrectal ultrasound guided prostate biopsy. Can J Urol. 2004; 11:2216–9.

19. Bergamini TM, Polk HC Jr. The importance of tissue antibiotic activity in the prevention of operative wound infection. J Antimicrob Chemother. 1989; 23:301–13.

20. Grabe M, Bjerklund-Johansen TE, Botto H, Çek M, Naber KG, Pickard RS, et al. Guidelines on urological infections. Eur Assoc Urology. 2013. 76–90.

21. 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:S1379–90.

22. Matsumoto T, Kiyota H, Matsukawa M, Yasuda M, Arakawa S, Monden K. Japanese Society of UTI Cooperative Study Group. Japanese guidelines for prevention of perioperative infections in urological field. Int J Urol. 2007; 14:890–909.

23. Kahlmeter G. Prevalence and antimicrobial susceptibility of pathogens in uncomplicated cystitis in Europe. The ECO.SENS study. Int J Antimicrob Agents. 2003; 22(Suppl 2):49–52.

24. Lee SJ. Current status of antimicrobial resistance among bacterial pathogens causing urinary tract infection in Korea. Korean J Urogenit Tract Infect Inflamm. 2009; 4:37–46.

25. Ryu KH, Kim MK, Jeong YB. A recent study on the antimicrobial sensitivity of the organisms that cause urinary tract infection. Korean J Urol. 2007; 48:638–45.

26. Çek M, Tandoğdu 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.

27. Naber KG, Bergman B, Bishop MC, Bjerklund-Johansen TE, Botto H, Lobel B, et al. Urinary Tract Infection (UTI) Working Group of the Health Care Office (HCO) of the European Association of Urology (EAU). EAU guidelines for the management of urinary and male genital tract infections. Urinary Tract Infection (UTI) Working Group of the Health Care Office (HCO) of the European Association of Urology (EAU). Eur Urol. 2001; 40:576–88.

28. 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.

29. Childs SJ. Appropriate surgical prophylaxis in transurethral genitourinary surgery and potential reduction in nosocomial infections. Urology. 1986; 27:415–20.

30. Bootsma AM, Laguna Pes MP, Geerlings SE, Goossens A. Antibiotic prophylaxis in urologic procedures: a systematic review. Eur Urol. 2008; 54:1270–86.

31. Terai A, Ichioka K, Kohei N, Ueda N, Utsunomiya N, Inoue K. Antibiotic prophylaxis in radical prostatectomy: 1-day versus 4-day treatments. Int J Urol. 2006; 13:1488–93.

32. Takeyama K, Takahashi S, Maeda T, Mutoh M, Kunishima Y, Matsukawa M, et al. Comparison of 1-day, 2-day, and 3-day administration of antimicrobial prophylaxis in radical prostatectomy. J Infect Chemother. 2007; 13:320–3.

33. Sakura M, Kawakami S, Yoshida S, Masuda H, Kobayashi T, Kihara K. Prospective comparative study of single dose versus 3-day administration of antimicrobial prophylaxis in minimum incision endoscopic radical prostatectomy. Int J Urol. 2008; 15:328–31.

34. Taoka R, Matsuoka T, Kita Y, Makino Y, Iha K, Soda T, et al. Antimicrobial prophylaxis in radical prostatectomy: single dose versus 1-day treatment. Hinyokika Kiyo. 2010; 56:559–63.

Table 1.

Recommended antibiotic agents for urologic surgery

Operation type	AUA²¹	EAU²⁰	JUA²²
Transurethral resection of prostate	FQ	2nd/3rd G CE	Broad-spectrum penicillins
	TMP-SMX	TMP-SMX	1st/2nd G CE
		Aminopenicillin+BLI	AG
Open or laparoscopic surgery with opening of urinary tract	1st/2nd G CE	2nd/3rd G CE	1st/2nd G CE
	AG+MET or CM	TMP-SMX	Penicillins/BLI

Aminopenicillin+BLI AUA: American Urological Association, EAU: European Association of Urology, JUA: Japanese Urological Association, FQ: fluoroquinolone, G:generation, CE: cephalosporin, TMP-SMX: trimethoprime-sulfamethoxazole, BLI: β-lactamase inhibitor, AG: aminoglycoside, MET: metronidazole, CM: clindamycin.

Table 2.

The three most preferred antibiotics in routine antibiotic prophylaxis according to regions²⁶

Procedure	Europe	Asia	Latin America	Africa	Global
TUR-P	1. Ciprofloxacin (23%)	1. Ciprofloxacin (18%)	1. 2G cephalosporins (31%)	1. 2G cephalosporins (30%)	1. Ciprofloxacin (20%)
	2. 2G cephalosporins (15%)	2. Cefotaxime (18%)	2. Amoxicillin+BLI (17%)	2. Gentamicin (15%)	2. 2G cephalosporins (15%)
	3. TMP–SMX (12%)	3. Ceftazidime (12%)	3. Ciprofloxacin (14%)	3. Amoxicillin+BLI (15%)	3. TMP–SMX (12%)
Open or laparoscopic urologic surgery (clean-contaminated)	1. 2G cephalosporins (22%)	1. Cefotaxime (23%)	1. 2G cephalosporins (30%)	1. 2G cephalosporins (23%)	1. Cefotaxime (21%)
	2. Cefotaxime (21%)	2. 2G cephalosporins (14%)	2. Cefotaxime (19%)	2. Ceftazidime (16%)	2. 2G cephalosporins (21%)
	3. Ciprofloxacin (14%)	3. Ceftazidime (13%)	3. Ciprofloxacin (13%)	3. Cefotaxime (13%)	3. Ciprofloxacin (12%)

TUR-P: transurethral resection of the prostate, 2G: second generation, TMP–SMX: trimethoprim-sulfamethoxazole, BLI: β-lactamase inhibitor.

Table 3.

Antimicrobial prophylaxis recommendation for TUR-P and prostatectomy in low-risk patients

Procedures	EAU 2001²⁷	EAU 2013²⁰	Grabe 2004¹	JUA 2007²²	AUA 2008²¹
TUR-P	No	Suggested (single dose) or no AMP	All patients (＜72 h)	All patients (＜72 h)	All patients (≤24 h)
Prostatectomy (open, laparo)	No	Suggested (single dose)	Suggested (single dose)	All patients (48–72 h)	All patients (≤24 h)

TUR-P: transurethral resection of the prostate, EAU: European Association of Urology, JUA: Japanese Urological Association, AUA: American Urological Association, AMP: antimicrobial prophylaxis.

Table 4.

Patient-related risk factors that may influence the risk for surgical site infection

General risk factors	Endogenous risk factors	Exogenous risk factors
High age	High age	Introduction of micro-organisms
Deficient nutritional status	Colonization	Instrumentation
Diabetes mellitus	Increased microbial burden	Catheterization
Smoking	Immunity (native or altered)	Central vein catheters
Extreme weight	Genetic determinants	Implantation of prosthetic devices
Coexisting infection at a remote site	Genitourinary anatomical factors	Sexual activity
Colonization with micro-organisms	Particular physiological status
Altered immune response	Concomitant diseases
Long preoperative hospital stay
Lack of elimination or control of risk factors

Table 5.

Classification of surgical field contamination of urologica procedures

Category of intervention	Open or laparoscopic urological surgery	Endoscopic urological instrumentation and surgery
Clean
Clean-contaminated T	Total/radical prostatectomy	TUR-P - No history UTI/UGI
		- Sterile urine
		- No catheter
Contaminated		TUR-P
		- History UTI/UGI
		- Catheter prior to
		surgery
		- Bacteriuria controlled
Dirty		- Clinical infected
		- Emergency

TUR-P: transurethral resection of the prostate, UTI: urinary trac infection, UGI: urogenital infection.

Table 6.

Antimicrobial prophylaxis in radical prostatectomy

Reference	Year	Nation (Case no.)	Antimicrobial prophylaxis	Surgical site infection	Remote infection	p-value
Terai et al.³¹	2006	Japan (106) retrospective	1 day:4 day 2nd CE	1.2%:0%	0%:0%	NS
Takeyama et al.³²	2007	Japan (67) retrospective	1, 2, 3 days			NS
Sakura et al.³³	2008	Japan (101) prospective	Single:3 days	6.1:3.8 (p=0.06)	2.0%:5.8% (p=0.33)	) NS
			TAZ/PIPC
Taoka et al.³⁴	2010	Japan (340) retrospective	Single dose vs. 1-day Tx 2nd CE	3.6:2.2	0.4%:0%	0.52

TAZ/PIPC: tazobactam/piperacillin, 2nd CE: second generation cephalosporin, NS: not significant, Tx: treatment.

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