J Korean Med Sci.  2017 Jun;32(6):1009-1015. 10.3346/jkms.2017.32.6.1009.

Antibiotic Prophylaxis in Radical Prostatectomy: Comparison of 2-Day and More than 2-Day Prophylaxis

• Shin B
• Chung HS
• Hwang EC
• Jung SI
• Kwon DD

• KMID: 2377732
• DOI: http://doi.org/10.3346/jkms.2017.32.6.1009

Abstract

The efficacy of antibiotic prophylaxis in radical prostatectomy (RP) remains to be established. We retrospectively compared the occurrence of perioperative infections after RP between the 2 different antibiotic protocols. This study involved 428 cases of laparoscopic radical prostatectomy (LRP). After excluding patients who had no perioperative urine culture data, 313 consecutive patients who underwent LRP for prostate carcinoma were classified into 2 groups according to the duration of antimicrobial prophylaxis. To group 1 (153 patients), a second-generation cephalosporin was administered for less than 2 days, whilst the remaining 160 patients in group 2 were administered the drug for more than 2 days. The overall incidence of postoperative bacteriuria was 50.8%, being significantly higher in group 1 (56.9%) than in group 2 (45%). The incidence of surgical site infection (SSI) was significantly higher in group 1 (5.2%) than in group 2 (0.6%). Multivariate analysis revealed that old age, duration of antibiotics for more than 2 days, and duration of Foley catheter placement were independently associated with postoperative infectious complications (all, P < 0.05). Multivariate analysis revealed that duration of antibiotics for more than 2 days, duration of Foley catheter placement, and duration of surgical drain placement were independently associated with postoperative SSI (all, P < 0.05). The incidence of postoperative bacteriuria and SSI were higher in patients who received antibiotics for a short duration. Based on our results, we demonstrated that the outcome of postoperative infectious complications is dependent on old age, short antibiotic administration duration, and prolonged Foley catheterization. Prolonged drain placement is associated with SSI, whilst a longer duration of antibiotics use and prolonged Foley catheterization are associated with a decrease in the incidence of SSI.

Keyword

Prostatectomy; Prophylaxis; Antibiotics; Foley; Infection

MeSH Terms

Anti-Bacterial Agents
Antibiotic Prophylaxis*
Bacteriuria
Catheters
Humans
Incidence
Multivariate Analysis
Prostate
Prostatectomy*
Retrospective Studies
Surgical Wound Infection
Urinary Catheterization
Anti-Bacterial Agents

Reference

1. Grabe M, Botto H, Cek M, Tenke P, Wagenlehner FM, Naber KG, Bjerklund Johansen TE. Preoperative assessment of the patient and risk factors for infectious complications and tentative classification of surgical field contamination of urological procedures. World J Urol. 2012; 30:39–50.

2. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999; 20:250–278.

3. Bootsma AM, Laguna Pes MP, Geerlings SE, Goossens A. Antibiotic prophylaxis in urologic procedures: a systematic review. Eur Urol. 2008; 54:1270–1286.

4. Terai A, Ichioka K, Kohei N, Ueda N, Utsunomiya N, Inoue K. Antibiotic prophylaxis in radical prostatectomy: 1-day versus 4-day treatments. Int J Urol. 2006; 13:1488–1493.

5. Takeyama K, Takahashi S, Maeda T, Mutoh M, Kunishima Y, Matsukawa M, Takagi Y. Comparison of 1-day, 2-day, and 3-day administration of antimicrobial prophylaxis in radical prostatectomy. J Infect Chemother. 2007; 13:320–323.

6. Sakura M, Kawakami S, Yoshida S, Masuda H, Kobayashi T, Kihara K. Prospective comparative study of single dose versus 3-day administration of antimicrobial prophylaxis in minimum incision endoscopic radical prostatectomy. Int J Urol. 2008; 15:328–331.

7. Wolf JS Jr, Bennett CJ, Dmochowski RR, Hollenbeck BK, Pearle MS, Schaeffer AJ; Urologic Surgery Antimicrobial Prophylaxis Best Practice Policy Panel. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol. 2008; 179:1379–1390.

8. Duclos JM, Larrouturou P, Sarkis P. Timing of antibiotic prophylaxis with cefotaxime for prostatic resection: better in the operative period or at urethral catheter removal? Am J Surg. 1992; 164:21S–3S.

9. Grabe M, Forsgren A, Hellsten S. A short antibiotic course given in conjunction with and after catheter removal consecutive to transurethral prostatic resection. Scand J Urol Nephrol. 1984; 18:193–199.

10. Matsumoto T, Kiyota H, Matsukawa M, Yasuda M, Arakawa S, Monden K; Japanese Society of UTI Cooperative Study Group. (Chairman; Tetsuro Matsumoto). Japanese guidelines for prevention of perioperative infections in urological field. Int J Urol. 2007; 14:890–909.

11. Sedor J, Mulholland SG. Hospital-acquired urinary tract infections associated with the indwelling catheter. Urol Clin North Am. 1999; 26:821–828.

12. Warren JW. Catheter-associated urinary tract infections. Int J Antimicrob Agents. 2001; 17:299–303.

13. Harding GK, Nicolle LE, Ronald AR, Preiksaitis JK, Forward KR, Low DE, Cheang M. How long should catheter-acquired urinary tract infection in women be treated? A randomized controlled study. Ann Intern Med. 1991; 114:713–719.

14. Rassweiler J, Seemann O, Schulze M, Teber D, Hatzinger M, Frede T. Laparoscopic versus open radical prostatectomy: a comparative study at a single institution. J Urol. 2003; 169:1689–1693.

15. Berry A, Barratt A. Prophylactic antibiotic use in transurethral prostatic resection: a meta-analysis. J Urol. 2002; 167:571–577.

16. Qiang W, Jianchen W, MacDonald R, Monga M, Wilt TJ. Antibiotic prophylaxis for transurethral prostatic resection in men with preoperative urine containing less than 100,000 bacteria per ml: a systematic review. J Urol. 2005; 173:1175–1181.

17. Stranne J, Aus G, Hansson C, Lodding P, Pileblad E, Hugosson J. Single-dose orally administered quinolone appears to be sufficient antibiotic prophylaxis for radical retropubic prostatectomy. Scand J Urol Nephrol. 2004; 38:143–147.

18. Hwang EC, Jung SI, Kwon DD, Lee G, Bae JH, Na YG, Min SK, Son H, Lee SJ, Chung JM, et al. A prospective Korean multicenter study for infectious complications in patients undergoing prostate surgery: risk factors and efficacy of antibiotic prophylaxis. J Korean Med Sci. 2014; 29:1271–1277.