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Prophylactic antibiotic use in transurethral prostatic resection: a meta-analysis.
Alexander Berry1, Alexandra Barratt
1Royal Prince Alfred Hospital, Newtown and Department of Public Health and Community Medicine, University of Sydney, Sydney, New South Wales, Australia.
The Journal of Urology
|January 17, 2002
Summary
Antibiotic prophylaxis significantly reduces infection rates after transurethral prostatic resection. This meta-analysis shows reduced bacteriuria and septicemia, with short-course regimens potentially being most effective.
Area of Science:
- Urology
- Infectious Diseases
- Evidence-Based Medicine
Background:
- Transurethral prostatic resection (TURP) is a common procedure for benign prostatic hyperplasia.
- TURP is classified as a clean-contaminated procedure, carrying a risk of postoperative infections.
- The incidence of bacteriuria and septicemia following TURP necessitates strategies to mitigate these risks.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy of antibiotic prophylaxis in men undergoing TURP.
- To evaluate the impact of antibiotic prophylaxis on postoperative bacteriuria and septicemia incidence.
Main Methods:
- Systematic review and meta-analysis of 32 randomized controlled trials (RCTs) involving 4,260 participants.
- Analysis focused on postoperative bacteriuria incidence (32 RCTs) and septicemia occurrence (8 RCTs).
Main Results:
- Antibiotic prophylaxis significantly decreased bacteriuria from 26% to 9.1% (RRR 65%) and clinical septicemia from 4.4% to 0.7% (RRR 77%).
- Effective antibiotic classes included quinolones, cephalosporins, co-trimoxazole, and aminoglycosides.
- Short-course antibiotic protocols showed potential for greater efficacy than single-dose regimens.
Conclusions:
- Antibiotic prophylaxis is effective in reducing bacteriuria and clinical septicemia in men undergoing TURP with sterile preoperative urine.
- A variety of antibiotic agents are effective, with short-course regimens possibly offering superior outcomes.
- Prophylactic antibiotics can prevent a substantial number of infections in patients undergoing TURP.