Double-blind study comparing aztreonam with placebo for prophylaxis of infection following prostatic surgery

Japanese guidelines for prevention of perioperative infections in urological field

For urologists, it is very important to master surgical indications and surgical techniques. On the other hand, the knowledge of the prevention of perioperative infections and the improvement of surgical techniques should always be considered. Although the prevention of perioperative infections in each surgical field is a very important issue, the evidence and the number of guidelines are limited. Among them, the preparation of guidelines has progressed, especially in gastrointestinal surgery. The Center for Disease Control and Prevention (CDC) proposed guidelines for the prevention of surgical site infections, which have been used worldwide. In urology, the original guidelines were different from those of general surgery, due to many endourological procedures and urine exposure in the surgical field. The Japanese Society of UTI Cooperative Study Group has thus framed these guidelines supported by The Japanese Urological Association. The guidelines consist of the following nine techniques: open surgeries, laparoscopic surgeries, transurethral resection of bladder tumor, ureterorenoscope and transurethral lithotripsy, transurethral resection of the prostate, prostate biopsy, cystourethroscope, pediatric surgeries in the urological field, and extracorporeal shock wave lithotripsy and febrile neutropenia. These are the first guidelines for the prevention of perioperative infections in the urological field in Japan. Although most of these guidelines were made using reliable evidence, there are parts without enough evidence. Therefore, if new reliable data is reported, it will be necessary for these guidelines to be revised in the future.

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.

Antimicrobial prophylaxis for surgery

Infection of the surgical wound or deep structures violated during surgery account for a major portion of postoperative morbidity. The medical consultant should have an understanding of the principles of antimicrobial prophylaxis for postoperative infection in order to manage this complication in the postoperative period. This article assesses the risks for infection, patient preparation for surgery, and antibiotic usage in frequently performed surgeries.

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 chemotherapy with fosfomycin trometamol versus placebo during transurethral prostatic resection

A prospective randomized controlled double-blind study was performed on 61 patients undergoing transurethral resection of the prostate. The first group of 31 patients received 3 g fosfomycin trometamol p.o. each on the evening before and after the operation; the second group of 30 patients received a placebo. Urine samples were taken by catheter puncture 24 and 48 h postoperative. After removal of the catheter (day 5) the first midstream urine was collected for culture, and from that moment on all patients were treated with a nitrofurantoin derivative for two weeks. Although the same strict antiseptic measures were standard practice for both groups, the incidence of early postoperative urinary tract infections was significantly lower for the fosfomycin trometamol group (0/31 versus 6/30 in placebo recipients). None of the patients suffered from a major symptomatic or complicated infection. There were no side effects registered.

Biofilms, bacteria and bladder catheters. A clinical study

Biofilms were present on 16 of 33 urethral catheters examined. In 11 cases the catheter carried a different microbial flora from that of the bladder urine. The length of time the catheter was in situ did not influence biofilm formation, and all types of materials tested supported biofilm growth. Biofilms were seen on 2 of the 7 catheters where prophylactic antibiotics had been used.