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Antimicrobial prophylaxis in urology and transplantation

World Journal of Surgery volume 6, pages 281–292 (1982)Cite this article

Abstract

The main source of infection in urological practice is from the presence of an indwelling catheter. The risk of catheteracquired infection is determined by the duration of catheterization, the adequacy of free drainage, and the efficiency of the closed drainage system. Many catheter-acquired infections are due to multiresistant strains of Escherichia coli, Klebsiella sp.,Pseudomonas aeruginosa, Proteus sp., and Providentia sp. Antibiotic prophylaxis has no place in the prevention of catheter-acquired infections, and prophylaxis should be achieved by scrupulous aseptic technique and reducing the duration of drainage. The problems of catheters in the paraplegic are discussed. Septicemia and endotoxemia are the most feared complications of cystoscopy and retropubic prostatectomy if the urinary tract is infected and of transrectal biopsy of the prostate. For this reason, antibiotic cover is generally advised for these procedures.

Sepsis is still a major cause of death in patients who have received a renal transplant. These infections are not only bacterial, but viral, protozoal, and fungal. The severity and frequency of these infections have been reduced by less aggressive immunosuppression. There is probably a place for perioperative antibiotic cover, but long-term antibiotics should be avoided.

Résumé

Le principale cause de l'infection en chirurgie urologique est représentée par la présence d'un cathéter. Le risque d'infection est alors fonction de la durée de son maintien de l'efficacité du drainage et du caractère hermétique de l'appareil collecteur des urines. L'infection urinaire acquise est due à des germes résistants escherichia coli, klebsiella, pseudomonas, proteus et providentia. L'antibiothérapie prophylactique n'a pas de place pour prévenir l'infection urinaire acquise par la voie d'un cathéter. La prévention de l'infection est obtenue en observant rigoureusement les règles de l'asepsie et en réduisant la durée du sondage urinaire.

Le problème de la sonde urinaire chez les paraplégiques est envisagé dans l'article.

Lorsque l'appareil urinaire est le siège d'une infection la septicémie et l'endotoxémie sont des complications à redouter au décours de la cystoscopie ou de la prostectomie rétro-pubienne. Il en est de même après biopsie prostatique par voie transrectale. Il est donc avisé d'assurer une protection antibiotique systématique lors de ces interventions.

Chez les transplantés rénaux l'infection reste une cause majeure de mortalité. L'infection est non seulement de type bactérien mais aussi de type viral ou mycosique. Sa gravité s'est réduite avec la réduction de l'immuno suppression. L'antibiothérapie d'encadrement opératoire a certainement sa place alors que l'emploi prolongé des antibiotiques doit être évité.

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  1. Department of Surgery, University Medical School, Teviot Place, EH8 9AG, Edinburgh, Scotland

    Geoffrey D. Chisholm Ch.M., F.R.C.S., F.R.C.S.E.

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Chisholm, G.D. Antimicrobial prophylaxis in urology and transplantation. World J. Surg. 6, 281–292 (1982). https://doi.org/10.1007/BF01653543

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Keywords

  • Pseudomonas Aeruginosa
  • Antibiotic Prophylaxis
  • Indwell Catheter
  • Antimicrobial Prophylaxis
  • Aseptic Technique