Hospital acquired pre-prostatectomy bacteriuria: risk factors and implications

One hundred and one consecutive prostatic patients with sterile urines were prospectively studied for the risk factors involved in the hospital acquired pre-prostatectomy bacteriuric and its implications. Eleven out of 101 patients (11%) became bacteriuric at operation whereas ninety of 101 patients (89%) remained abacteriuric. Nine of the eleven bacteriuric patients (82%) had pre-operative indwelling urethral catheters compared to 37/90 (41%) abacteriurics (P < 0.05). Mean catheter duration was 22.22 and 9.92 days respectively (P < 0.05). Three out of eleven (27%) bacteriuric patients had chronic retention of urine compared to one of ninety (1%) abacteriuric patients. Past history of acute retention, vesical stones, vesical diverticulae, diabetes mellitus and azotaemia were not significant risk factors. Post-operative fever did not correlate with positive blood cultures. However, eight of the eleven (73%) bacteriurics developed bacteraemia compared to only one out of ninety (1%) abacteriuric patients. It is concluded that the significant risk factors which would be strong indications for antimicrobial prophylaxis in prostatectomy are chronic retention of urine and prolonged pre-operative indwelling urethral catheterization for more than ten days. Azotaemia, diabetes mellitus and associated bladder pathologies were not significant and therefore do not warrant antimicrobial prophylaxis.