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Falkensammer E, Erenler E, Johansen TEB, Tzelves L, Schneidewind L, Yuan Y, Cai T, Koves B, Tandogdu Z. Antimicrobial Prophylaxis in Robot-Assisted Laparoscopic Radical Prostatectomy: A Systematic Review. Antibiotics (Basel) 2023; 12:1744. [PMID: 38136777 PMCID: PMC10740870 DOI: 10.3390/antibiotics12121744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
It remains unclear whether antibiotic prophylaxis (AP) should be recommended or discouraged in robot-assisted laparoscopic radical prostatectomy (RALP) for prostate cancer (PCa). The development of microbial resistance and side effects are risks of antibiotic use. This systematic review (SR) investigates the evidence base for AP in RALP. A systematic literature search was conducted until 12 January 2023, using Embase, MEDLINE, Cochrane CENTRAL, Cochrane CDSR (via Ovid) and CINAHL for studies reporting the effect of AP on postoperative infectious complications in RALP. Of 436 screened publications, 8 studies comprising 6378 RALP procedures met the inclusion criteria. There was no evidence of a difference in the rate and severity of infective complications within 30 days after RALP surgery between different AP protocols. No studies omitted AP. For patients who received AP, the overall occurrence of postoperative infectious complications varied between 0.6% and 6.6%. The reported urinary tract infection (UTI) rates varied from 0.16% (4/2500) to 8.9% (15/169). Wound infections were reported in 0.46% (4/865) to 1.12% (1/89). Sepsis/bacteraemia and hyperpyrexia were registered in 0.1% (1/1084) and 1.6% (5/317), respectively. Infected lymphoceles (iLC) rates were 0.9% (3 of 317) in a RALP cohort that included 88.6% pelvic lymph node dissections (PLND), and 3% (26 of 865) in a RALP cohort where all patients underwent PLND. Our findings underscore that AP is being administered in RALP procedures without scientifically proven evidence. Prospective studies that apply consistent and uniform criteria for measuring infectious complications and antibiotic-related side effects are needed to ensure the comparability of results and guidance on AP in RALP.
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Affiliation(s)
- Eva Falkensammer
- Department of Urology, Klinikum Wels-Grieskirchen, 4600 Wels, Austria
- Department of Pediatric Surgery, University Hospital Salzburg, 5020 Salzburg, Austria
| | - Ece Erenler
- School of Medicine, Koc University, Istanbul 34450, Turkey;
| | - Truls E. Bjerklund Johansen
- Department of Urology, Oslo University Hospital, 0424 Oslo, Norway;
- Institute of Clinical Medicine, University of Aarhus, 8000 Aarhus, Denmark
| | - Lazaros Tzelves
- Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, 11527 Athens, Greece
| | - Laila Schneidewind
- Department of Urology, University Greifswald, 17487 Greifswald, Germany;
| | - Yuhong Yuan
- Department of Medicine, London Health Science Centre, London, ON N6A 5W9, Canada;
- Department of Medicine, Health Sciences Centre, McMaster University, Hamilton, ON N6A 5W9, Canada
| | - Tommaso Cai
- Department of Urology, Santa Chiara Hospital, 38123 Trento, Italy;
- Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway
| | - Bela Koves
- Department of Urology, South-Pest Teaching Hospital, 1097 Budapest, Hungary
| | - Zafer Tandogdu
- Department of Urology, University College London Hospitals, London NW1 2BU, UK;
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A New Gold Rush: A Review of Current and Developing Diagnostic Tools for Urinary Tract Infections. Diagnostics (Basel) 2021; 11:diagnostics11030479. [PMID: 33803202 PMCID: PMC7998255 DOI: 10.3390/diagnostics11030479] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 11/16/2022] Open
Abstract
Urinary tract infections (UTIs) are one of the most common infections in the United States and consequently are responsible for significant healthcare expenditure. The standard urine culture is the current gold standard for diagnosing urinary tract infections, however there are limitations of the test that directly contribute to increased healthcare costs. As a result, new and innovative techniques have been developed to address the inefficiencies of the current standard-it remains to be seen whether these tests should be performed adjunctly to, or perhaps even replace the urine culture. This review aims to analyze the advantages and disadvantages of the newer and emerging diagnostic techniques such as PCR, expanded quantitative urine culture (EQUC), and next generation sequencing (NGS).
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Dixon M, Sha S, Stefil M, McDonald M. Is it Time to Say Goodbye to Culture and Sensitivity? The Case for Culture-independent Urology. Urology 2019; 136:112-118. [PMID: 31786305 DOI: 10.1016/j.urology.2019.11.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/28/2019] [Accepted: 11/25/2019] [Indexed: 12/12/2022]
Abstract
Next-generation sequencing has highlighted the limitations of conventional culture methods in the role of urology while discovering the intricate details of the role of microbiota in urologic health and disease. This review article explores: the utility and limitations of conventional culture methods; how culture-independent technologies are revolutionizing medicine; and how the implementation of these technologies may lead to improved patient outcomes. Finally, this article discusses the barriers to widespread adoption of culture-independent technologies, with suggestions for how these hurdles may be overcome.
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Affiliation(s)
- Matthew Dixon
- Norwich Medical School, University of East Anglia, Norwich, UK.
| | - Sybil Sha
- Geisel School of Medicine, Dartmouth College, Hanover, NH
| | - Maria Stefil
- Norwich Medical School, University of East Anglia, Norwich, UK
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Johansen TEB, Zahl PH, Baco E, Bartoletti R, Bonkat G, Bruyere F, Cai T, Cek M, Kulchavenya E, Köves B, Mouraviev V, Pilatz A, Tandogdu Z, Tenke P, Wagenlehner FME. Antibiotic resistance, hospitalizations, and mortality related to prostate biopsy: first report from the Norwegian Patient Registry. World J Urol 2019; 38:17-26. [PMID: 31183524 DOI: 10.1007/s00345-019-02837-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/03/2019] [Indexed: 12/27/2022] Open
Affiliation(s)
- Truls E Bjerklund Johansen
- Department of Urology, Oslo University Hospital, Nydalen, Po. Box 4959, 0424, Oslo, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Per-Henrik Zahl
- Domain for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Eduard Baco
- Department of Urology, Oslo University Hospital, Nydalen, Po. Box 4959, 0424, Oslo, Norway
| | | | - Gernot Bonkat
- Department of Urology, alta uro AG, Basel, Switzerland
| | - Franck Bruyere
- Urologie, 2 bd Tonnelle, 37044, Tours, France
- Université Francois Rabelais de Tours, PRES Centre val de Loire, 37044, Tours, France
| | - Tommaso Cai
- Department of Urology, Santa Chiara Hospital, Trento, Italy
| | - Mete Cek
- Department of Urology, Medical Faculty of Trakya University, Edirne, Turkey
| | - Ekaterina Kulchavenya
- Urogenital Department, Novosibirsk Research TB Institute, 630040, Novosibirsk, Russian Federation
| | - Bela Köves
- South-Pest Teaching Hospital, Budapest, Hungary
| | - Vladimir Mouraviev
- University of Central Florida, Orlando, FL, USA
- Central Florida Cancer Institute, Davenport, FL, USA
| | - Adrian Pilatz
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen Justus-Liebig-Universität Gießen, Rudolf-Buchheim-Str. 7, 35392, Giessen, Germany
| | - Zafer Tandogdu
- Department of Urology, Oslo University Hospital, Nydalen, Po. Box 4959, 0424, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Peter Tenke
- South-Pest Teaching Hospital, Budapest, Hungary
| | - Florian M E Wagenlehner
- Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen Justus-Liebig-Universität Gießen, Rudolf-Buchheim-Str. 7, 35392, Giessen, Germany
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Tailored perioperative antimicrobial prophylaxis in urological surgery: myth or reality? Curr Opin Urol 2018; 27:112-119. [PMID: 27861259 DOI: 10.1097/mou.0000000000000363] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW The controversies surrounding perioperative antimicrobial prophylaxis (AMP) are about the use and especially misuse of antibiotics. The overall lack of evidence to facilitate a rational perioperative AMP policy in urological surgery and the postoperative infectious complications remain a challenge. Therefore, a basic tool to aid decision-making would be useful. A model based on the patients' risk factors, the level of contamination and grading of surgical procedures is discussed. RECENT FINDINGS A series of studies have shown that infectious complications and healthcare-associated infections remain consistently at an average of 10%, with a great variation in frequency dependent on the patients' preoperative status and the type, severity and contamination level of the surgical procedure. Preoperative patient assessment and preparation are key factors for well tolerated surgery and recovery. Adherence to the guidelines appears to reduce both the prescription of antimicrobials and the total costs without risking the patient outcome. Several studies of a series of interventions such as cystoscopy, endoscopic stone surgery and selected clean-contaminated interventions give support to the model. Bacteriuria, upgrading the patient to the contaminated level, requires preoperative control. SUMMARY The discussed model assists the urologists in decision-making on perioperative AMP and contributes to a responsible use of antibiotics.
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