Antibiotic prophylaxis in TURP: a prospective analysis concerning antibiotic stewardship and a potential reduction of antibiotic use in TURP

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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Authors

Contributions

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.

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Correspondence to E. Baten.

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We have nothing to disclose.

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Informed consent was obtained for every patient.

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Baten, E., Van Der Aa, F., Orye, C. et al. Antibiotic prophylaxis in TURP: a prospective analysis concerning antibiotic stewardship and a potential reduction of antibiotic use in TURP. World J Urol 37, 2467–2472 (2019). https://doi.org/10.1007/s00345-019-02676-z

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Keywords

  • TURP
  • Antibiotics
  • Microbial resistance
  • Bacteriuria