Antibiotic prophylaxis in transurethral resection of the prostate with reference to the influence of preoperative...

The value of prophylactic antibiotics in transurethral resection of the prostate (TURP) remains controversial. We have conducted a prospective study in which 308 patients undergoing TURP have been randomized to receive no antibiotic cover (n = 150) or 36 h perioperative cover with temocillin. In 62 patients the urine was found to be infected at the time of operation. In these patients the incidence of postoperative urinary-tract infection (UTI) was 33% in the group who received temocillin, and 87% in the control group (P less than 0.001). In patients with sterile urine at operation (n = 235), the incidence of postoperative UTI was 13% in the temocillin group compared with 24% in the control group (P less than 0.05). Gram-positive organisms were mainly responsible for infection which occurred in patients who had received temocillin. A high incidence of postoperative UTI occurred in patients who had required preoperative catheterization despite the fact that their preoperative urine specimen was sterile. We conclude, (i) prophylactic antibiotics are of benefit in patients undergoing TURP, (ii) the antibiotic administered should be active against both gram-positive and gram-negative organisms, (iii) patients with an indwelling catheter should be considered at a higher risk of infection whether or not organisms are cultured from their preoperative urine specimen.