Single dose, oral antibiotic cover for transurethral prostatectomy

A double-blind, randomised, placebo-controlled study was carried out to determine the incidence and significance of bacteriuria in 110 patients undergoing transurethral resection of the prostate (TURP) and to assess the effect of a single pre-operative dose of Ciprofloxacin, a 4-quinolone antibiotic. Fifteen (68%) of the 22 patients in the placebo group with a positive post-operative urine culture subsequently developed a clinically apparent urinary tract infection (UTI) or received antibiotics in view of a positive urine culture. Adequate prostatic concentrations of Ciprofloxacin were achieved in all who received the drug. A significant reduction in the number of positive post-operative urine cultures and urinary tract infections requiring antibiotic therapy was achieved in this group. Six patients (5.5%) developed clinical evidence of septicaemia, 5 of whom were in the placebo group. No organisms resistant to Ciprofloxacin were encountered. Prior to surgery, 19% of all patients were found to have previously unsuspected bacteriuria. Ciprofloxacin tended to reduce the chances of this group developing a UTI or requiring antibiotics. Further, there was a highly significant reduction in post-operative infective complications in those with sterile urine at the time of resection who had received the drug. This study suggests that antibiotic cover for TURP is of clinical benefit. Ciprofloxacin may prove suited to this purpose, although further experience with the drug is still required.     

Oral ciprofloxacin as prophylaxis for optical urethrotomy

It is known that urethral strictures predispose to bacteriuria. We studied a series of patients undergoing optical urethrotomy to see if antibiotic prophylaxis was justified. Twenty-three patients were randomised to receive either no prophylaxis or a short peri-operative course of oral ciprofloxacin. Two patients with sterile pre-operative urine and two patients with pre-operative bacteriuria given no prophylaxis had post-operative bacteriuria, whereas all patients given ciprofloxacin had sterile urine after operation. Antibiotic prophylaxis may be indicated in patients undergoing optical urethrotomy.     

Norfloxacin prophylaxis for endoscopic urological surgery.

A series of 140 patients, undergoing various types of urological endoscopic procedures, was divided into 2 equal, parallel, randomised groups. The first group of 70 patients, undergoing lower urinary tract surgery, was randomised, half to receive norfloxacin prophylaxis and half no antibiotic cover; the other 70 patients, undergoing percutaneous renal surgery, were randomised, half to receive norfloxacin and half cefuroxime. It was found that 26% of patients not receiving antibiotic prophylaxis and 11% on cefuroxime prophylaxis developed post-operative bacteriuria, with a high incidence of urinary tract infection (UTI). Only 1 patient of 70 on norfloxacin prophylaxis developed post-operative bacteriuria, which quickly responded to prolongation of norfloxacin therapy. Prior to surgery, 10% of all patients were found to have previously undetected bacteriuria. This group was at high risk of developing post-operative infection. Norfloxacin effectively prevented post-operative bacteriuria and urinary tract infection in these patients. This study suggests that norfloxacin is a safe and effective prophylactic antibiotic in all forms of urological endoscopic procedures.     

Prophylactic cefuroxime in transurethral resection

Summary 65 men undergoing elective transurethral resection of the prostate under the care of one urologist entered a randomised controlled trial using Cefuroxime. Patients were excluded if they had received antibiotics in a 2 week period before surgery, if they had positive pre-operative urine cultures or if they had been catheterised. 58 patients completed the study. One patient in the antibiotic group and 2 in the control group developed urinary infection. The overall infection rate was 5.17%. The control and antibiotic groups were comparable as regards age and the duraction of resection. One patient in the antibiotic group developed an allergic reaction. It is felt that routine antibiotic prophylaxis in patients with sterile urine undergoing elective TUR is unnecessary.     

内毒素测定评价预防性抗生素在前列腺穿刺活检中的应用价值

目的 :探讨内毒素 (ET)测定在评价经直肠前列腺穿刺活检的感染危险性和预防性抗生素中的应用价值。方法 :4 8例患者随机分成无预防性处理组 (A组 ,12例 )、预防性抗生素组 (B组 ,13例 )、术前灌肠组 (C组 ,12例 )和联合处理组 (D组 ,11例 )共 4组 ,穿刺前、后分别留取血液和尿液 ,用于细菌培养和ET测定。其中ET采用鲎试验的偶氮显色法 (LQACT)测定。　结果 :前列腺穿刺前、后各组血清ET浓度变化和血培养结果无统计学意义 (P >0 .0 5 ) ;A和B组穿刺后尿ET明显升高 (P <0 .0 5 ) ,而C和D组无明显升高 (P >0 .0 5 ) ;A和B组穿刺后尿培养细菌阳性率明显增高 (P <0 .0 5 ) ,而C和D组无明显增高 (P >0 .0 5 )。　结论 :前列腺穿刺活检引起内毒素血症可能性很小 ;术前灌肠和 /或联合预防性抗生素可减少前列腺穿刺引起尿路感染 ;血液、尿液ET测定对经直肠前列腺穿刺活检所致感染的诊断意义较大。     

Urinary tract infections and post-operative fever in percutaneous nephrolithotomy

Purpose

To review the incidence of UTIs, post-operative fever, and risk factors for post-operative fever in PCNL patients.

Materials and methods

Between 2007 and 2009, consecutive PCNL patients were enrolled from 96 centers participating in the PCNL Global Study. Only data from patients with pre-operative urine samples and who received antibiotic prophylaxis were included. Pre-operative bladder urine culture and post-operative fever (>38.5°C) were assessed. Relationship between various patient and operative factors and occurrence of post-operative fever was assessed using logistic regression analyses.

Results

Eight hundred and sixty-five (16.2%) patients had a positive urine culture; Escherichia coli was the most common micro-organism found in urine of the 350 patients (6.5%). Of the patients with negative pre-operative urine cultures, 8.8% developed a fever post-PCNL, in contrast to 18.2% of patients with positive urine cultures. Fever developed more often among the patients whose urine cultures consisted of Gram-negative micro-organisms (19.4–23.8%) versus those with Gram-positive micro-organisms (9.7–14.5%). Multivariate analysis indicated that a positive urine culture (odds ratio [OR] = 2.12, CI [1.69–2.65]), staghorn calculus (OR = 1.59, CI [1.28–1.96]), pre-operative nephrostomy (OR = 1.61, CI [1.19–2.17]), lower patient age (OR for each year of 0.99, CI [0.99–1.00]), and diabetes (OR = 1.38, CI [1.05–1.81]) all increased the risk of post-operative fever. Limitations include the use of fever as a predictor of systemic infection.

Conclusions

Approximately 10% of PCNL-treated patients developed fever in the post-operative period despite receiving antibiotic prophylaxis. Risk of post-operative fever increased in the presence of a positive urine bacterial culture, diabetes, staghorn calculi, and a pre-operative nephrostomy.     

Single-dose antibiotic prophylaxis in core prostate biopsy: Impact of timing and identification of risk factors

OBJECTIVES: To assess the level of infectious complications and the impact of timing of a single, prophylactic, oral dose of ciprofloxacin 750 mg given either 2 hours before or in conjunction with ultrasound-guided core biopsy of the prostate in men without recognised risk factors and to analyse potential risk factors. METHODS: All men undergoing prostate biopsy for elevated prostate specific antigen or clinical suspected prostate cancer were enrolled in an open, comparative prospective study. Excluded were men with recognised risk factors for infective complications. Two end points were chosen: febrile genitourinary infection and the results of postbiopsy urine culture. RESULTS: A total of 1322 prostate biopsy occasions were made in 1157 men. Twelve (0.9%) cases of febrile genitourinary infections were recorded, two of which had proven sepsis. Administrating the drug 2 hours before or at the time of biopsy (p > 0.5) showed no statistical difference. Eight of 12 patients were shown to have prebiopsy undisclosed risk factors. Four percent developed postbiopsy, asymptomatic, significant bacteriuria. In addition, three (27%) men with prebiopsy unrecognised bacteriuria, who were accidentally enrolled, developed febrile genitourinary infection; one had proven sepsis. CONCLUSIONS: A single high-dose of oral ciprofloxacin 750 mg can be administered in direct conjunction with prostate biopsy to men without recognised risk factors, keeping the infection rate at approximately 1%. Bacteriuria before biopsy is a major risk factor for infective complications. Attention given to recognising individual risk factors would reduce the risk of infection further.     

Antibiotic prophylaxis for transurethral prostatic resection in men with preoperative urine containing less than 100,000 bacteria per ml: a systematic review

PURPOSE: We determined whether antibiotic prophylaxis can reduce the risk of postoperative infective complications in men undergoing transurethral resection of the prostate (TURP) who have preoperative urine with less than 100,000 bacteria per ml. MATERIALS AND METHODS: MEDLINE, EMBASE (Elsevier B.V., Amsterdam, The Netherlands) and the Cochrane Library were searched for randomized and quasi-randomized controlled trials that compared the effects of antibiotic prophylaxis with placebo or active controls for men undergoing TURP with preoperative sterile urine. Two reviewers independently extracted patient characteristic and outcomes data based on a prospectively developed protocol. RESULTS: A total of 28 trials, 10 placebo controlled and 18 no treatment controlled, involving 4,694 patients, met the inclusion criteria. The mean age of the subjects was 69 years and the majority underwent TURP for prostatic hyperplasia (85%). Antibiotic prophylaxis was significantly more effective than placebo in reducing postoperative TURP complications. The risk differences for post-TURP bacteriuria, high degree fever, bacteremia and use of additional antibiotic treatment were -0.17 (95% CI 0.20, -0.15), -0.11 (-0.15, -0.06), -0.02 (-0.04, 0.00) and -0.20 (-0.28, -0.11), respectively. The results were observed consistently across all classes of antibiotics assessed. There was no difference in the duration of postoperative catheterization or hospitalization. Adverse events were rare, generally mild, and included allergic reactions, pyrexia and abdominal complaints. CONCLUSIONS: Prophylactic antibiotics decrease the incidence of post-TURP bacteriuria, high fever, bacteremia and additional antibiotic treatment. Additional research should evaluate the optimal antibiotic regimen, and whether the cost and possibility of the development of resistant strains of organisms justify the routine use of prophylactic antibiotics.     

Bacteriuria and safety of female urodynamic studies

Introduction and hypothesis

Our aim was to study the incidence of bacteriuria after urodynamic studies (UDS) and prevalence of asymptomatic bacteriuria before UDS.

Methods

In this prospective study between March and September 2011, 140 women undergoing UDS were subjected to urine culture before the investigation. Urine was collected aseptically with a sterile catheter transurethrally. Multichannel UDS were performed 3–5 days after urine collection. Prophylactic antibiotics were not administered to these women. A second urine sample was collected within 5–7 days after UDS. Significant bacteriuria was defined as 10² colony-forming units (cfu)/ml or more of a single organism cultured.

Results

Thirty (21.4 %) women had asymptomatic bacteriuria before UDS and were excluded from the main study group. Among the 110 women in the study group, 4 (3.6 %) acquired infection after UDS. Three grew organisms found in the vagina (group B Streptococcus and yeast-like organism) and one grew Proteus mirabilis. Age 60 years and above is a significant risk factor. In contrast to the study group, among 30 women who had infection before UDS, Escherichia coli was the commonest pathogen in 19 (63.3 %) and 30 % had diabetes. Eleven (36.7 %) had persistent infection after UDS and the rest resolved spontaneously. In addition, no other related complication was observed on the UDS.

Conclusions

This study shows that risk of post UDS bacteriuria is low in women and screening for vaginal infections may be necessary before UDS. Women over 60 years old are significantly at risk of infection. Bacteriuria is nevertheless mostly asymptomatic and transient in nature.     

Comparison of local povidone-iodine antisepsis with parenteral antibacterial prophylaxis for prevention of infective complications of TURP: a prospective randomized controlled study

OBJECTIVE: To determine whether antisepsis with povidone-iodine solution applied at the external urethral meatus confers protection against infective complications following transurethral resection of the prostate (TURP) and compare that with antibacterial prophylaxis. METHODS: A total of 167 patients with sterile urine undergoing TURP for benign prostatic hyperplasia (BPH) were prospectively randomized into three groups. Group A, had gauze soaked in saline applied at the urethral meatus (control group). In group B, the gauze was soaked in povidone-iodine instead of saline and group C had a single 1 g i.v. injection of cephradine at induction of anaesthesia with no treatment for the meatus. Bacteraemia, post-operative bacteriuria and other infective complications were compared in the three groups. Associations of bacteriuria at catheter removal and intra-operative bacteraemia with infective complications and with long term bacteriuria were also studied. RESULTS: Bacteriuria rate at catheter removal was not significantly different in the three groups. However, intraoperative bacteraemia and bacterial growth at the external urethral meatus was significantly lower in group C. Bacteriuria at catheter removal was significantly associated with bacterial growth at the meatus but not with long term bacteriuria at 3 months. Bacteriuria at catheter removal could not accurately predict infective complications. CONCLUSION: Post-TURP bacteriuria appears to be preceded by bacterial growth at the external urethral meatus. Antisepsis with povidone-iodine solution application at the meatus does not confer adequate protection against meatal bacterial growth as that obtained by prophylactic antibacterials. Nonetheless, neither antibacterial prophylaxis nor local antisepsis could reduce bacteriuria rate in this study.     

Quantitative bacterial tissue cultures from 209 prostatectomy specimens: findings and implications

To define the prevalence of prostatic bacterial infection or colonization, tissue from 209 patients undergoing prostatectomy (204 transurethral and 5 suprapubic) was submitted for quantitative bacterial tissue cultures. Tissue from 44 patients (21 per cent) yielded positive, single organism bacterial growth. In an attempt to identify preoperatively this patient subgroup, multiple preoperative and intraoperative variables were examined. Although the presence of a preoperative indwelling catheter was associated with positive prostate cultures, only 34 per cent (24 of 70) of the patients with preoperative catheters had positive prostate cultures. Of the 44 patients with positive prostate cultures 36 (82 per cent) had sterile urine cultures documented preoperatively, all urine specimens having been obtained in the absence of antibiotics. The data support a significant prevalence (21 per cent or more) of prostatic infection in patients undergoing prostatic surgery for obstructive symptoms and an apparent paucity of reliable indicators by which to identify preoperatively this patient population.     

前列腺细菌感染与前列腺摘除术细菌感染的关系

目的：探讨增生前列腺组织细菌感染与前列腺摘除术细菌感染的关系。　方法：对７５ 例前列腺增生症病例作前列腺摘除术的前列腺组织进行细菌培养，同时作血液和尿液细菌培养。　结果：７５ 例中，前列腺组织细菌培养阳性 ３０ 例（４０％ ）。术前置管导尿的病例前列腺细菌感染率较高，为５４．５％ ；术前未行导尿的病例前列腺细菌感染率较低，为１９．４％ 。术前有菌尿症的病例，８７．５％ 有前列腺细菌感染；术前无菌尿症的病例，仅２１．３％ 有前列腺细菌感染。术中或术后菌血症占１０．７％ 。前列腺有细菌感染的病例，术后菌尿症发病率较高，为４０％ ；前列腺未发现细菌的病例，术后菌尿症发病率较低，为１１．１％ 。　结论：留置导尿管和菌尿症的病人前列腺细菌感染率较高，有前列腺细菌感染的病例发生术中、术后菌血症和术后菌尿症的危险性较高。     

Microbiological outcomes in women with diabetes and untreated asymptomatic bacteriuria

Background: Asymptomatic bacteriuria is common in diabetic women. Treatment of asymptomatic bacteriuria is not beneficial, but the natural history of the microbiology of asymptomatic bacteriuria has not been well described. Objective: To describe the microbiological outcomes of bacteriuria in diabetic women with untreated asymptomatic bacteriuria. Methods: Study subjects were initially identified through ambulatory endocrinology clinics. They were enrolled if they had two positive urine cultures ≥10⁸ cfu/l with the same organism within 2 weeks and no symptoms referable to urinary tract infection. Women initially received a 2-week course of placebo with follow-up cultures obtained at the end of treatment and 4 weeks post-treatment. Subsequently, the prevalence of bacteriuria was determined with urine cultures obtained every 3 months to a maximum of 36 months. Outcomes at yearly intervals were designated as one of: persistent bacteriuria; spontaneous resolution; resolution with antibiotics for symptomatic urinary infection; or resolution with antibiotics given for other indications. Women with and without persistent or frequent bacteriuria were compared to identify variables associated with bacteriuria. Results: The prevalence of bacteriuria in the study cohort declined to about 50% by 9 months, and subsequently remained stable throughout 3 years follow-up. Almost 20% of subjects remained bacteriuric with the original infecting organism throughout the period of observation. With evaluation at 12-month intervals, approximately one-quarter of subjects had each of the four potential outcomes of: resolution following antibiotic therapy for symptomatic urinary infection, following antibiotic therapy for other indications, spontaneous resolution without antibiotics, and persistent bacteriuria with the same organism. Women infected with gram-negative organisms were more likely to have persistent bacteriuria. Many women with resolution of initial bacteriuria, with or without antibiotics, became bacteriuric again during follow-up. Conclusions: Women with asymptomatic bacteriuria and diabetes tend to have persistent or recurrent asymptomatic bacteriuria. Bacteriuria is benign, and seldom permanently eradicable.     

整形门诊手术前后抗生素应用对比观察

本文总结了１５４６例整形门诊手术病例,通过对术前、术后使用抗生素的对比观察,说明在手术室条件不变及术者相对固定的情况下,术前预防性使用抗生素优于术后使用抗生素。所有病例分术前用药组和术后用药组,按手术类型、手术部位、急诊与否、有否植入体等分项对比,并就对比项目列表作统计学分析。结果表明术前使用抗生素感染率为０％,术后组为２．９１％,经统计学分析Ｐ＜０．００１。结论：①通过对比观察,表明术前用药可有效地发挥抗生素作用,降低感染率,优于术后用药;②有植入体或涉及软骨组织的手术宜术前使用抗生素,急诊手术或血供较差部位的手术应术前使用抗生素;③选择的药物应抗菌谱广,吸收迅速,低价,使用方便。术前用药强调剂量要足量;④术前抗生素应在术前２小时内给药。     

Treatment of cervico-prostatic obstruction by endoscopic incision of the prostate. Apropos of 16 patients

Several teams over recent years have proposed deep transurethral incision of the prostate as treatment for obstructive symptoms secondary to primary bladder neck sclerosis or to a small prostatic adenoma. We have performed this technique in 16 patients over a period of 9 months: 9 cases of primary bladder neck sclerosis and 7 prostatic adenomas weighing less than 20 grams. There were no post-operative complications. This technique was definitely effective on the dysuria with 93% good results at 6 months. The preservation of post-operative anterograde ejaculation was less certain; 27% of our patients developed post-operative retrograde ejaculation. The indication for TUI amongst the other available surgical techniques depends on a rigorous pre-operative assessment evaluating the size and the nature of the obstruction. It is a remarkably simple technique which effectively cures the dysuria. It also markedly decreases the risk of retrograde ejaculation. As this complication is difficult to predict, the patients should be informed of the risks prior to the operation.     

Incidence and risk factors of bacteriuria after transurethral resection of the prostate

INTRODUCTION: Postoperative bacteriuria is a frequent event after transurethral resection of the prostate, despite the use of prophylactic antibiotics. Certain risk factors have been clearly established (preoperative urinary catheter or bacteriuria, operating time), while others remain uncertain. MATERIALS AND METHODS: We conducted a prospective study in five urology centers, including non-catheterized patients with sterile preoperative urine undergoing transurethral resection of the prostate for benign prostatic hyperplasia. All received antibiotic prophylaxis with cefamandole. The incidence of bacteriuria and its risk factors were investigated. RESULTS: The postoperative bacteriuria rate was 26% (26/101), with 8% on removal of the catheter, 14% between the 7th and 10th postoperative days and 5% 1 month postoperatively. Factors associated with bacteriuria on univariate analysis were: operating time, disconnection of the closed urine drainage system and postoperative catheterization > or =3 days. Two variables were associated on multivariate analysis (logistic regression): operating time >52 min (odds ratio 9.0, 95% confidence interval 2.1-39.0) and disconnection of the closed urine drainage system (odds ratio 26.3, 95% confidence interval 6.1; 6.1-113). CONCLUSIONS: The postoperative bacteriuria rate after transurethral resection of the prostate was high in this study, raising the question of the choice and/or duration of prophylactic antibiotics. Prevention of postoperative bacteriuria must be based on careful hemostasis, prevention of postoperative catheter disconnections, and limitation of the duration of postoperative catheterization.     

Antibiotic prophylaxis in percutaneous nephrolithotomy: prospective study in 81 patients

PURPOSE: To compare single-dose and short-course antibiotic prophylaxis protocols in percutaneous nephrolithotomy. PATIENTS AND METHODS: Eighty-one patients with sterile urine preoperatively who underwent percutaneous nephrolithotomy were divided into two groups. The first group (N = 43) received a single intravenous dose of antibiotic (200 mg of ofloxacin) during anesthetic induction, and the second group (N = 38) received treatment doses of antibiotic (400 mg of ofloxacin per day) until the nephrostomy catheter was removed. The two groups were identical according to demographic and treatment characteristics. For each patient, microbiologic evaluation of extracted stones and urine samples was done. If patients developed fever in the postoperative period, blood and urine cultures were taken. Factors that might have affected the development of postoperative fever and infection were analyzed. RESULTS: Nine patients in the first group had postoperative fever. Three had bacteriuria, and one had bacteremia. In the second group, eight patients had fever. One had bacteriuria and bacteremia. Nineteen patients (eleven in the first group, eight in the second) had positive stone cultures. No statistical difference was observed between the two groups in terms of bacteriuria, bacteremia, positive stone cultures, or postoperative fever. The febrile patients had longer operations with the use of more irrigation fluid and longer postoperative hospital stays. CONCLUSIONS: In patients whose preoperative urine cultures are sterile, short-term prophylaxis has no advantage over single-dose prophylaxis as a means of preventing infection. The duration of surgery and the amount of irrigation fluid are significant risk factors for postoperative fever.     

Infectious complications after transurethral resection]

300 consecutive TUR were prospectively examined bacteriologically. We used, lacking contraindications, Co-Trimoxazol as antibiotic prophylaxis, when urine at admittance was sterile, otherwise we treated the urinary infection. The antibiotics were applied from the beginning of the intervention until the catheter was removed. Of the 49 patients with a indwelling catheter 28 (57%) had an urinary infection. All but one were cured. 2 of 64 (3%) patients undergoing resection of a bladder tumour acquired asymptomatic nosocomial infection. 198 patients underwent TUR of the prostate with initially sterile urine. 7 patients suffered from fever in the postoperative course, in 6 cases the origin remained unclear. 3 patients showed an asymptomatic nosocomial infection. Overall, with antibiotic prophylaxis we found an infection rate of 2-5% for the TUR of the prostate and of 3% for the TUR of bladder. Primarily infected urine, in this study, did not elevate the risk for infectious complications.     

Controlled trial of intravesical noxythiolin in the prevention of infection following outflow tract surgery

A randomised control trial was undertaken in 100 consecutive patients undergoing endoscopic surgery for outflow tract obstruction to assess the efficacy of noxythiolin in preventing post-operative bacteriuria; 1% noxythiolin or sterile water was instilled at the time of catheter removal. The incidence of bacteriuria in the treated group (7/50) was significantly lower than in the control group (19/50). This was statistically significant. This difference was more marked in patients who had been catheterised for retention of urine. There was no difference in the complication rate despite a reduction of infection in the treated group.