Antibiotic Prophylaxis in Men Undergoing Transurethral Resection of Prostate: A Systematic Review and Network
Alessandro V Oliveira1,2, Ana Luiza N Sampaio1,2, Edson Luis B Siqueira1
1Department of Medicine, University of Pará State, Belém, Brazil.
Summary
Antibiotic prophylaxis (ATBp) significantly reduces infection risks, including bacteriuria and septicemia, following transurethral resection of the prostate (TURP). Different antibiotic classes offer varying effectiveness, guiding optimal prophylaxis strategies.
Area of Science:
- Urology
- Infectious Diseases
- Pharmacology
Background:
- Transurethral resection of the prostate (TURP) is a common procedure with a risk of post-operative infections.
- Antibiotic prophylaxis (ATBp) is often administered to mitigate these risks, but optimal choices require evidence-based ranking.
Purpose of the Study:
- To analyze the efficacy of antibiotic prophylaxis (ATBp) before transurethral resection of the prostate (TURP).
- To rank different antibiotic classes for their effectiveness in preventing complications associated with TURP.
Main Methods:
- A systematic search of multiple databases (PubMed, Web of Science, Embase, CENTRAL) and clinical trials registries was conducted for randomized controlled trials (RCTs) up to October 2024.
- A frequentist network meta-analysis was performed on 45 RCTs (n=6939) comparing ATBp to placebo/no agent and to each other, estimating risk ratios and mean differences.
- Treatments were ranked using the surface under the cumulative ranking (SUCRA) to determine the best-performing antibiotic classes.
Main Results:
- ATBp significantly reduced the risk of early and late bacteriuria, septicemia/bacteremia, and fever compared to placebo or no agent.
- A reduction in length of hospital stay was also observed with ATBp.
- No significant differences were found in the rates of death or adverse effects between ATBp and placebo/no agent groups.
- Specific antibiotic regimens demonstrated superior rankings for different outcomes, such as 1st generation cephalosporin plus nitrofuran for early bacteriuria and phosphonic acid for fever.
Conclusions:
- Antibiotic prophylaxis is superior to placebo or no agent for most endpoints in TURP procedures.
- The choice of antibiotic class significantly influences efficacy, necessitating careful consideration for optimal prophylaxis.
- Routine ATBp before TURP is recommended, guided by the ranked effectiveness of different antibiotic classes.
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