Antibiotic prophylaxis in TURP: a prospective analysis concerning antibiotic stewardship and a potential reduction of antibiotic use in TURP
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Antibiotic prophylaxis is standard procedure in transurethral resection of the prostate (TURP). We evaluated the necessity of antibiotic (AB) prophylaxis in TURP due to increasing microbial antibiotic resistance.
This is a prospective cohort study of 506 patients. Only patients with a pre-operative catheter/pyuria received AB-prophylaxis. Urine analysis (pre-operative, at discharge, and 3 week post-operative) was performed next to an analysis of the blood culture/irrigation fluid and of the resected prostatic tissue. Statistical analysis was performed using Fisher’s exact test.
67/506 (13.2%) patients received prophylactic antibiotics. 56/67 (83.5%) patients had a pre-operative catheter and 11/67 (16.4%) had pre-operative pyuria in which a fluoroquinolone-resistance (FQ-R) rate of 69.2% in Escherichia coli (EC) was observed.
Clinical infectious symptoms were present in 13/439 (2.9%) patients without antibiotic prophylaxis; 12/439 (2.7%) patients had uncomplicated fever (<38.5°) during or after hospitalization and only 1/439 patient (0.2%) was high degree fever (> 38.5°) observed.
Uncomplicated fever developed in 7/67 (10.4%) patients who did receive AB-prophylaxis.
FQ-R was observed in 60% of the positive urine cultures at discharge and in 53.8% 3 week post-operatively.
Our data show a low infectious complication rate (2.9%) in patients without a pre-operative catheter or pyuria,undergoing TURP without AB-prophylaxis. These findings might question the current use of AB prophylaxis in TURP in patients without a pre-operative catheter or pyuria, in times of antibiotic stewardship due to the high rate of microbial-resistance in our population.
KeywordsTURP Antibiotics Microbial resistance Bacteriuria
EB: protocol/project development; data collection or management; data analysis; manuscript writing/editing. FA: manuscript writing/editing. CO: data collection or management. RC: protocol/project development. IA: manuscript writing/editing. KR: protocol/project development; data collection or management; manuscript writing/editing.
Compliance with ethical standards
Conflict of interest
We have nothing to disclose.
Informed consent was obtained for every patient.
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