Antimicrobial Prophylaxis in Urological Surgery

Shingo Yamamoto; Katsumi Shigemura; Hiroshi Kiyota; Soichi Arakawa

doi:10.14777/uti.2016.11.03.77

Journal List > Urogenit Tract Infect > v.11(3) > 1084209

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Yamamoto, Shigemura, Kiyota, Arakawa, and Japanese Research Group for UTI: Antimicrobial Prophylaxis in Urological Surgery

Review

Urogenit Tract Infect 2016;11(3):77-85.

Published online: 19 January 2016

DOI: https://doi.org/10.14777/uti.2016.11.03.77

Antimicrobial Prophylaxis in Urological Surgery

Shingo Yamamoto, Katsumi Shigemura, Hiroshi Kiyota, Soichi Arakawa; Japanese Research Group for UTI

Department of Urology, Hyogo College of Medicine, Hyogo, Japan

Correspondence to: Shingo Yamamoto http://orcid.org/0000-0001-6032-0557 Department of Urology, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo 663-8501, Japan Tel: +81-798-45-6366, Fax: +81-798-45-6368 E-mail: shingoy@hyo-med.ac.jp

Received 18 September 2016 Revised 17 October 2016 Accepted 17 October 2016

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

Surgical site infection (SSI) is defined as an infection occurring within one month from surgery or intervention. SSIs are classified into three categories: Clean, clean-contaminated, and contaminated. They are defined as procedures that avoid entering the urinary tract, involve entry of the urinary tract, and involve the bowels, respectively. The purpose of antimicrobial prophylaxis (AMP) is to protect the surgical wound from contamination by normal bacterial flora. AMP should be based on penicillin with beta-lactamase inhibitors, or first- or second-generation cephalosporins. Broad-spectrum antimicrobials, such as third- and fourth-generation cephalosporins or carbapenems, should be used to treat postoperative infections but not AMP. AMP should be started no less than 30 minutes prior to the start of the operation. AMP should be administered by a single dose or be terminated within 24 hours in cases of transurethral, clean, or clean-contaminated surgery, and within 2 days in cases of bowl (contaminated) surgery. These guidelines are applicable preoperatively only for non-infected, low-risk patients. The risk of patients for infection should be evaluated preoperatively, such as with a urine culture test. In cases with preoperative infection or bacteriuria that can cause an SSI or urinary tract infection following surgery, patients must receive adequate preoperative treatment based on their individual situation.

Keywords: Surgical wound infection, Antimicrobial prophylaxis, Urological surgery

REFERENCES

1.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.

2.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.

3.Yamamoto S., Shigemura K., Kiyota H., Wada K., Hayami H., Yasuda M, et al. Essential Japanese guidelines for the prevention of perioperative infections in the urological field: 2015 edition. Int J Urol. 2016. 23:814–24.

4.Grabe M., Bjerklund-Johansen TE., Botto H., Çek M., Naber KG., Pickard RS, et al. Perioperative antibacterial prophylaxis in urology. Guidelines on urological infections. Arnhem: European Association of Urology;2013. p. 76–85.

5.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.

6.Koch CG., Li L., Hixson E., Tang A., Gordon S., Longworth D, et al. Is it time to refine? An exploration and simulation of optimal antibiotic timing in general surgery. J Am Coll Surg. 2013. 217:628–35.

7.Togo Y., Tanaka S., Kanematsu A., Ogawa O., Miyazato M., Saito H, et al. Antimicrobial prophylaxis to prevent perioperative infection in urological surgery: a multicenter study. J Infect Chemother. 2013. 19:1093–101.

8.McDonald M., Grabsch E., Marshall C., Forbes A. Single- versus multiple-dose antimicrobial prophylaxis for major surgery: a systematic review. Aust N Z J Surg. 1998. 68:388–96.

9.Ho VP., Barie PS., Stein SL., Trencheva K., Milsom JW., Lee SW, et al. Antibiotic regimen and the timing of prophylaxis are important for reducing surgical site infection after elective abdominal colorectal surgery. Surg Infect (Larchmt). 2011. 12:255–60.

10.George AK., Srinivasan AK., Cho J., Sadek MA., Kavoussi LR. Surgical site infection rates following laparoscopic urological procedures. J Urol. 2011. 185:1289–93.

11.Tanaka K., Arakawa S., Miura T., Shigemura K., Nakano Y., Takahashi S, et al. Analysis of isolated bacteria and short-term antimicrobial prophylaxis with tazobactam-piperacillin (1: 4 ratio) for prevention of postoperative infections after radical cystectomy. J Infect Chemother. 2012. 18:175–9.

12.Shigemura K., Tanaka K., Matsumoto M., Nakano Y., Shirakawa T., Miyata M, et al. Post-operative infection and prophylactic antibiotic administration after radical cystectomy with orthotopic neobladder urinary diversion. J Infect Chemother. 2012. 18:479–84.

13.Taoka R., Togo Y., Kubo T., Kido M., Miki K., Kiyota H, et al. Assessment of antimicrobial prophylaxis to prevent perioperative infection in patients undergoing prostate brachytherapy: multicenter cohort study. J Infect Chemother. 2013. 19:926–30.

14.Dicker AP., Figura AT., Waterman FM., Valicenti RK., Strup SE., Gomella LG. Is there a role for antibiotic prophylaxis in transperineal interstitial permanent prostate brachytherapy? Tech Urol. 2000. 6:104–8.

15.Alsaywid BS., Smith GH. Antibiotic prophylaxis for transurethral urological surgeries: systematic review. Urol Ann. 2013. 5:61–74.

16.Yokoyama M., Fujii Y., Yoshida S., Saito K., Koga F., Masuda H, et al. Discarding antimicrobial prophylaxis for transurethral resection of bladder tumor: a feasibility study. Int J Urol. 2009. 16:61–3.

17.Berry A., Barratt A. Prophylactic antibiotic use in transurethral prostatic resection: a meta-analysis. J Urol. 2002. 167:571–7.

18.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.

19.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/sulfa-methoxazole versus a control group in patients undergoing TUR of the prostate. Eur Urol. 2005. 47:549–56.

20.Sohn DW., Kim SW., Hong CG., Yoon BI., Ha US., Cho YH. Risk factors of infectious complication after ureteroscopic procedures of the upper urinary tract. J Infect Chemother. 2013. 19:1102–8.

21.Matsumoto M., Shigemura K., Yamamichi F., Tanaka K., Nakano Y., Arakawa S, et al. Prevention of infectious complication and its risk factors after urological procedures of the upper urinary tract. Urol Int. 2012. 88:43–7.

22.Paick SH., Park HK., Oh SJ., Kim HH. Characteristics of bacterial colonization and urinary tract infection after indwelling of double-J ureteral stent. Urology. 2003. 62:214–7.

23.Ozgur BC., Ekıcı M., Yuceturk CN., Bayrak O. Bacterial colonization of double J stents and bacteriuria frequency. Kaohsiung J Med Sci. 2013. 29:658–61.

24.Lu Y., Tianyong F., Ping H., Liangren L., Haichao Y., Qiang W. Antibiotic prophylaxis for shock wave lithotripsy in patients with sterile urine before treatment may be unnecessary: a systematic review and meta-analysis. J Urol. 2012. 188:441–8.

25.Shen P., Jiang M., Yang J., Li X., Li Y., Wei W, et al. Use of ureteral stent in extracorporeal shock wave lithotripsy for upper urinary calculi: a systematic review and meta-analysis. J Urol. 2011. 186:1328–35.

26.Fujita K., Mizuno T., Ushiyama T., Suzuki K., Hadano S., Satoh S, et al. Complicating risk factors for pyelonephritis after extracorporeal shock wave lithotripsy. Int J Urol. 2000. 7:224–30.

27.Shigeta M., Yamasaki A., Hayashi M. A clinical study on upper urinary tract calculi treated with extracorporeal shock wave lithotripsy (ESWL) monotherapy, with regard to bacteriuria before ESWL treatment. Nihon Hinyokika Gakkai Zasshi. 1993. 84:866–72.

28.Dinçel C., Ozdiler E., Ozenci H., Tazici N., Koşar A. Incidence of urinary tract infection in patients without bacteriuria undergoing SWL: comparison of stone types. J Endourol. 1998. 12:1–3.

29.Charton M., Vallancien G., Veillon B., Brisset JM. Urinary tract infection in percutaneous surgery for renal calculi. J Urol. 1986. 135:15–7.

30.Doğan HS., Sahin A., Cetinkaya Y., Akdoğan B., Ozden E., Kendi S. Antibiotic prophylaxis in percutaneous nephrolithotomy: prospective study in 81 patients. J Endourol. 2002. 16:649–53.

31.Mariappan P., Smith G., Moussa SA., Tolley DA. One week of ciprofloxacin before percutaneous nephrolithotomy significantly reduces upper tract infection and urosepsis: a prospective controlled study. BJU Int. 2006. 98:1075–9.

32.Bag S., Kumar S., Taneja N., Sharma V., Mandal AK., Singh SK. One week of nitrofurantoin before percutaneous nephrolithotomy significantly reduces upper tract infection and urosepsis: a prospective controlled study. Urology. 2011. 77:45–9.

33.Knopf HJ., Graff HJ., Schulze H. Perioperative antibiotic prophylaxis in ureteroscopic stone removal. Eur Urol. 2003. 44:115–8.

34.Togo Y., Kubo T., Taoka R., Hiyama Y., Uehara T., Hashimoto J, et al. Occurrence of infection following prostate biopsy procedures in Japan: Japanese Research Group for Urinary Tract Infection (JRGU)-a multicenter retrospective study. J Infect Chemother. 2014. 20:232–7.

35.Carignan A., Roussy JF., Lapointe V., Valiquette L., Sabbagh R., Pepin J. Increasing risk of infectious complications after transrectal ultrasound-guided prostate biopsies: time to reassess antimicrobial prophylaxis? Eur Urol. 2012. 62:453–9.

36.Hasegawa T., Shimomura T., Yamada H., Ito H., Kato N., Hasegawa N, et al. Fatal septic shock caused by transrectal needle biopsy of the prostate; a case report. Kansenshogaku Zasshi. 2002. 76:893–7.

37.Kato R., Suzuki Y., Matsuura T., Sato K., Shimaya R., Fujishima Y, et al. Septic shock due to fluoroquinolone-resistant Escherichia coli after transrectal prostate needle biopsy. Hinyokika Kiyo. 2010. 56:453–6.

38.Ozden E., Bostanci Y., Yakupoglu KY., Akdeniz E., Yilmaz AF., Tulek N, et al. Incidence of acute prostatitis caused by extended-spectrum beta-lactamase-producing Escherichia coli after transrectal prostate biopsy. Urology. 2009. 74:119–23.

39.Sabbagh R., McCormack M., Peloquin 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.

40.Shigemura K., Tanaka K., Yasuda M., Ishihara S., Muratani T., Deguchi T, et al. Efficacy of 1-day prophylaxis medication with fluoroquinolone for prostate biopsy. World J Urol. 2005. 23:356–60.

41.Schaeffer AJ., Montorsi F., Scattoni V., Perroncel R., Song J., Haverstock DC, et al. Comparison of a 3-day with a 1-day regimen of an extended-release formulation of ciprofloxacin as antimicrobial prophylaxis for patients undergoing transrectal needle biopsy of the prostate. BJU Int. 2007. 100:51–7.

42.Batura D., Rao GG., Bo Nielsen P., Charlett A. Adding amikacin to fluoroquinolone-based antimicrobial prophylaxis reduces prostate biopsy infection rates. BJU Int. 2011. 107:760–4.

43.Shigemura K., Matsumoto M., Tanaka K., Yamashita M., Arakawa S., Fujisawa M. Efficacy of combination use of beta-lactamase inhibitor with penicillin and fluoroquinolones for antibiotic prophylaxis in transrectal prostate biopsy. Korean J Urol. 2011. 52:289–92.

44.Yasuda M., Nakane K., Yamada Y., Matsumoto M., Sho T., Matsumoto M, et al. Clinical effectiveness and safety of tazobactam/piperacillin 4.5 g for the prevention of febrile infectious complication after prostate biopsy. J Infect Chemother. 2014. 20:631–4.

45.Li CK., Tong BC., You JH. Cost-effectiveness of culture-guided antimicrobial prophylaxis for the prevention of infections after prostate biopsy. Int J Infect Dis. 2016. 43:7–12.

46.Summers SJ., Patel DP., Hamilton BD., Presson AP., Fisher MA., Lowrance WT, et al. An antimicrobial prophylaxis protocol using rectal swab cultures for transrectal prostate biopsy. World J Urol. 2015. 33:2001–7.

47.Gottesman T., Yossepowich O., Harari-Schwartz O., Tsivian A., Idler J., Dan M. The value of rectal cultures in treatment of sepsis following post-transrectal ultrasound-guided prostate biopsy. Urol Int. 2015. 95:177–82.

48.Phillips S. The comparison of double gloving to single gloving in the theatre environment. J Perioper Pract. 2011. 21:10–5.

49.Misteli H., Weber WP., Reck S., Rosenthal R., Zwahlen M., Fueglistaler P, et al. Surgical glove perforation and the risk of surgical site infection. Arch Surg. 2009. 144:553–8.

50.Haynes AB., Weiser TG., Berry WR., Lipsitz SR., Breizat AH., Dellinger EP, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009. 360:491–9.

Table 1.

Surgical categories for urological surgery

Transurethral/endoscopic surgery

TURBT, TURP, transurethral ureterolithotripsy, percutaneous nephrolithotripsy

Open/laparoscopic surgery

Clean

Nephrectomy, adrenalectomy, partial nephrectomy, intra-abdominal lymph node dissection, inguinal or scrotum surgery

Clean-contaminated

Nephroureterectomy, prostatectomy, vesico-ureteral neostomy, partial cystectomy, cystectomy (uretero-cutaneostomy), renal transplantation

Contaminated (using bowels)

Cystectomy (ileal-conduit, neobladder), bladder augmentation

TURBT: transurethral resection of bladder tumor, TURP: transurethral resection of the prostate.

Table 2.

AMP for open and laparoscopic urological surgery

Classification	Antimicrobials	Duration
Open/laparoscopic
Clean	1st generation cephalosporins, or penicillins with BLIs^a)	Single dose (no AMP for low risk cases)
Clean-contaminated	1st or 2nd generation cephalosporins, or penicillins with BLIs^a)	Single dose or terminated within 24 hours
Contaminated (using bowels)	2nd generation cephalosporins, cephamycins, or penicillins with BLIs	Single dose or terminated within 48 hours
Prostate brachytherapy	1st generation cephalosporins, or penicillins with BLIs^a), or oral quinolones	Single dose

AMP: antimicrobial prophylaxis, BLIs: beta-lactamase inhibitors.

^a) Except for tazobactam/piperacillin.

Table 3.

AMP for transurethral endoscopic urological surgery

Classification	Antimicrobials	Duration
TURBT	1st or 2nd generation cephalosporins, or penicillins with BLIs^a), or aminoglycosides	Single dose or terminated within 24 hours^b)
TURP	1st generation cephalosporins, or penicillins with BLIs^a), or aminoglycosides	Single dose or terminated within 72 hours
HoLEP/TUEB (hospitalized)	1st or 2nd generation cephalosporins or penicillins with BLIs^a), or aminoglycosides	Single dose or terminated within 48 hours
HoLEP/TUEB (outpatient surgery)	1st or 2nd generation cephalosporins, or penicillins with BLIs^a), or aminoglycosides	Single dose
HoLEP/TUEB (outpatient surgery)	with oral quinolones or cephalosporins	3 days (additional dosing optional)
Transurethral surgery for upper urinary tract	1st or 2nd generation cephalosporins, or penicillins with BLIs^a), or aminoglycosides, or oral quinolones	Single dose or terminated within 24 hours

AMP: antimicrobial prophylaxis, TURBT: transurethral resection of bladder tumor, TURP: transurethral resection of the prostate, HoLEP: holmium laser enucleation of the prostate, TUEB: transurethral enucleation with bipolar, BLIs: beta-lactamase inhibitors.

^a) Except tazobactam/piperacillin,

^b) low-risk cases without preoperative urinary tract infection can be considered to require no AMP.

Table 4.

AMP for urinary stone surgery

Classification	Antimicrobials	Duration
Shock wave lithotripsy
Low risk	None	No AMP
High risk (bacteriuria, infected stone, endoscopic manipulation, repeated SWL history of febrile urinary tract infection, stone diameter ≥2 cm)	2nd or 3rd generation cephalosporins, or penicillins with BLIs^a), or aminoglycosides, or oral quinolones or sulfamethoxazole/trimethoprim	Single dose
Percutaneous nephrolithotripsy
Low risk	1st or 2nd generation cephalosporins, or penicillins with BLIs^a), or aminoglycosides	Single dose
High risk (stone diameter ≥2 cm, hydronephrosis)	1st or 2nd generation cephalosporins, or penicillins with BLIs^a), or aminoglycosides	Preoperative antimicrobial therapy
Transurethral ureterolithotripsy	1st or 2nd generation cephalosporins, or penicillins with BLIs^a), or aminoglycosides	Single dose

AMP: antimicrobial prophylaxis, BLIs: beta-lactamase inhibitors.

^a) Except for tazobactam/piperacillin.

Table 5.

AMP for prostate biopsy

Approach	Antimicrobials	Duration
Transperineal	Oral levofloxacin (500 mg)	Single dose
Trans-rectal
Low risk	Oral levofloxacin (500 mg)+aminoglycosides	Single dose
High risk^a)	Tazobactam/piperacillin (4.5 g)	Twice for one day

^a) High risk: prostate volume ≥75 ml, diabetes, steroid dosing, immune-deficiency status, severe voiding disturbance (IPSS ≥20, Q_max of ≤12 ml/s, residual volume ≥100 ml).

TOOLS

Similar articles