Antimicrobial prophylaxis in transurethral resection of the prostate:perioperative application and evaluation
Objective To evaluate the safety and validity of perioperative antimicrobial prophylaxis with different administration period in patients undergoing transurethral resection of the prostate(TURP)for benign prostatic hyperplasia(BPH).Methods This prospective randomized controlled clinical trial was conducted on patients who underwent TURP in the Second Affiliated Hospital of Anhui Medical University from July 2022 to December 2023.The patients were randomly assigned to the experimental group and the control group in a 1∶1 ratio using a randomized block design.Inclusion criteria:age 55-78 years old,the indication of benign prostatic hyperplasia surgery,preoperative urine routine examination showed no pyuria or bacteriuria,preoperative catheterization being not reserved,postoperative pathology confirmed BPH and informed consent obtained.Exclusion criteria:severe heart,lung,brain and other diseases which could not tolerate anesthesia and surgery,complicated with bladder stones or bladder tumors,diabetic patients with poor glycemic control,immunosuppressive agents being administered.Patients in the experimental group received a single dose of cephalosporins or fluoroquinolones 30 minutes or 2 hours before surgery,while patients in the control group received a second dose 12 hours or 24 hours after the first dose.The primary outcome was the incidence of urinary tract infectious presenting fever(body temperature ≥38.5℃)within 1 week after surgery,while the white blood cell count,C-reactive protein concentration,serum heparin-binding protein concentration,red and white blood cell count in urine,the incidence of bacteriuria,pulmonary infection,and postoperative hospital stay were defined as secondary outcomes.The safety index was the incidence of adverse reactions of antibiotics.Results A total of 180 patients were enrolled in this study,including 90 cases in each experimental group or control group.Two groups of patients had no significant difference(P＞0.05)in age[(71.7±3.9)and(69.9±4.8)years],prostate volume[55.0 ml(39.5,62.0)and 52.5(45.5,68.5)ml],operation time[(58.8±17.0)min vs.(60.9±16.7)min],and postoperative indwelling catheter days[3.0(3,4)d vs.3.8(3,4)d].The incidence of fever within 1 week after surgery was 7.8％(7/90)in the experimental group and 5.6％(5/90)in the control group,respectively,and the difference was not statistically significant(P=0.550).Our data demonstrated that the white blood cell count[(10.5±1.2)×109/L vs.(9.7±4.1)×109/L],C-reactive protein concentration[(43.0±27.9)mg/L vs.(53.1±29.9)mg/L]and heparin-binding protein concentration[(44.7±19.4)ng/ml vs.(37.8±23.5)ng/tnl],urine red blood cell count[4 768.2(2 387.9,10496.5)/μl vs.6 577.2(3 691.5,7 636.8)/μl],urine white blood cell count[447.1(283.9,637.0)/μl vs 242.8(109.7,691.8)/μl]were mildly elevated in two groups without significant difference(P＞0.05).The incidence of postoperative pulmonary infection[3.3％(3/90)]vs.2.2％(2/90)],bacteriuria[6.7％(6/90)vs.8.9％(8/90)],postoperative hospital stay[4.5(4.0,5.1)days vs.4.5(4.0,5.5)days]also showed no significant difference(P＞0.05).While the incidence of adverse reactions of antibiotics in the experimental group 3.3％(3/90)was significantly lower than that in the control group 11.1％(10/90)(P=0.044).Conclusions A single-dose antibiotic administration as a perioperative antimicrobial prophylaxis is safe and effective for patients undergoing TURP who do not have preoperative pyuria or indwelling catheter.
Transurethral resection of the prostateBenign prostatic hyperplasiaAntimicrobial prophylaxis
万方数据
维普
