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Antibiotic compared with antiseptic prophylaxis for prostatic surgery
S Prescott1, M A Hadi, R A Elton
1Department of Surgery/Urology, Western General Hospital, Edinburgh.
Abstract:
Two different regimens of cephalosporin antibiotic prophylaxis were compared with antiseptic lubricating jelly to try to prevent infection and complications in 196 men after prostatic surgery. Pre-operative urine was cultured and prostatic chips (170 cases) were also cultured to define the source of any infection. The use of antibiotics was associated with a reduced risk of postoperative bacteriuria. No serious complications occurred, although 1 patient in the antiseptic treated group developed rigors; 79 of 170 patients (46%) had positive prostatic chip cultures, of whom 74 had sterile pre-operative urine. There was no association between the result of chip culture and the presence of a pre-operative catheter. Culture positive patients had an increased risk of post-operative urine infection, although the same organism was found in the prostate and urine in only 36% of cases of post-operative bacteriuria and in 43 (54%) the organism cultured from the prostate was Staphylococcus albus. This study provides further evidence of the benefit of true prophylactic antibiotic therapy for transurethral prostatic surgery and the prostatic chip data suggest that some of the risk is due to pre-operative contamination of the prostate in the absence of per-operative urinary infection or catheterisation.
Insights
Prophylactic cephalosporin antibiotics significantly reduced postoperative bacteriuria in men undergoing prostatic surgery. Prostatic chip cultures revealed pre-operative contamination as a risk factor, even without urinary infection.
Area of Science:
- Urology
- Infectious Disease Prevention
- Surgical Site Infection Control
Background:
- Postoperative infection is a concern following prostatic surgery.
- Antiseptic lubricating jelly was compared against antibiotic prophylaxis.
- Understanding infection sources is crucial for prevention strategies.
Purpose of the Study:
- To evaluate the efficacy of cephalosporin antibiotic prophylaxis versus antiseptic jelly in preventing infection after prostatic surgery.
- To identify the source of infection through pre-operative urine and prostatic chip cultures.
- To assess the association between prostatic cultures and postoperative outcomes.
Main Methods:
- A comparative study involving 196 men undergoing prostatic surgery.
- Pre-operative urine and prostatic chip cultures (170 cases) were performed.
- Two cephalosporin regimens were compared with antiseptic lubricating jelly.
Main Results:
- Antibiotic prophylaxis was linked to a lower risk of postoperative bacteriuria.
- 46% of prostatic chip cultures were positive, often with sterile pre-operative urine.
- Positive chip cultures correlated with an increased risk of postoperative urine infection.
Conclusions:
- Prophylactic antibiotic therapy offers significant benefits for transurethral prostatic surgery.
- Pre-operative prostatic contamination, not just urinary infection, contributes to surgical risk.
- Further evidence supports the use of antibiotics to prevent infection in these procedures.