Prospective comparative study of single dose versus 3-day administration of antimicrobial prophylaxis in minimum
Mizuaki Sakura1, Satoru Kawakami, Souichiro Yoshida
1Department of Urology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
Objective:
From the critical stand point against the overuse of antimicrobial agents, appropriate reduction of antimicrobial prophylaxis (AMP) should be considered. We have prospectively reduced AMP and evaluated the occurrence of surgical site infection (SSI) following radical retropubic prostatectomy (RRP) by minimum incision endoscopic surgery (MIES).
Methods:
A total of 101 consecutive patients who underwent MIES-RRP for prostate carcinoma were classified into two groups according to AMP dose. The 3-day group of 52 patients received tazobactam sodium/piperacillin sodium (TAZ/PIPC) 2.5 g intravenously before the operation and continued twice daily until postoperative day 2, and the single dose group of 49 patients received TAZ/PIPC 2.5 g intravenously only once before the operation. Additional antimicrobial agents were given only when SSI occurred. The occurrence of SSI and remote infection (RI) were analyzed.
Results:
There was no significant difference in the rate of SSI occurrence between the 3-day group (3.8%) and single dose group (6.1%) (P = 0.6). RI did not increase in the single dose group.
Conclusion:
Antimicrobial prophylaxis dose was successfully reduced without increasing SSI or RI. A single dose of AMP is feasible to prevent SSI and RI and would be a standard regimen in MIES-RRP. Active surveillance of postoperative infection is mandatory to promptly administer antimicrobial treatment as the need arises.
Insights
Reducing antimicrobial prophylaxis (AMP) for radical retropubic prostatectomy (RRP) using minimum incision endoscopic surgery (MIES) is safe. A single dose of AMP effectively prevents surgical site infections (SSI) and remote infections (RI).
Area of Science:
- Urology
- Surgical Oncology
- Infectious Disease
Background:
- Overuse of antimicrobial agents necessitates reducing antimicrobial prophylaxis (AMP).
- Surgical site infection (SSI) is a concern following radical retropubic prostatectomy (RRP).
- Minimum incision endoscopic surgery (MIES) is an evolving surgical approach.
Purpose of the Study:
- To prospectively evaluate the reduction of AMP in MIES-RRP.
- To assess the impact of reduced AMP on SSI and remote infection (RI) rates.
- To determine the feasibility of a single-dose AMP regimen.
Main Methods:
- 101 patients undergoing MIES-RRP were divided into a 3-day AMP group (n=52) and a single-dose AMP group (n=49).
- Tazobactam sodium/piperacillin sodium (TAZ/PIPC) was administered intravenously.
- SSI and RI occurrences were analyzed; additional antibiotics were given only if infection developed.
Main Results:
- No significant difference in SSI rates between the 3-day (3.8%) and single-dose (6.1%) groups (P = 0.6).
- Remote infection rates did not increase in the single-dose AMP group.
- Tazobactam sodium/piperacillin sodium (TAZ/PIPC) was the antimicrobial agent used.
Conclusions:
- Antimicrobial prophylaxis dose can be safely reduced in MIES-RRP without increasing SSI or RI.
- A single dose of AMP is a feasible and effective standard regimen for MIES-RRP.
- Active surveillance for postoperative infections is crucial for prompt treatment.
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