Antibiotic prophylaxis for genitourinary surgery in community hospitals

For 92 patients who had undergone transurethral and open urologic surgery a prospective, randomized, double-blind study was done that compared the effects of ceftriaxone, a third generation cephalosporin, to placebo. The 2 groups were similar in respect to demographic characteristics. Ceftriaxone reduced significantly the incidence of postoperative infection (p less than 0.01). Of 43 patients who received ceftriaxone 2 (5 per cent) became infected compared to 15 of 49 (30 per cent) who received placebo. Patients in the placebo group who had positive postoperative urine cultures did so approximately 2 days earlier than those in the ceftriaxone group, even though the day of catheter removal averaged about 1 1/2 days later in the ceftriaxone group. There was no correlation between the incidence of fever and infection, and there was no difference between groups with regard to postoperative bleeding, or the incidence of recatheterization or rehospitalization. Average operating time, highest temperature postoperatively and number of hospital days were approximately the same in both groups. Two patients in the placebo group had serious complications and incurred approximately $11,600 in additional expenses as a result of those complications. Of these patients 1 became septic, and 1 had urinary tract and wound infections postoperatively. These data suggest that this method of antibiotic prophylaxis will not only reduce the incidence of postoperative infection in such patients, thereby reducing morbidity, mortality and hospital costs, but also may provide an additional 1 to 2 days of protection from infection for patients who require postoperative catheterization.