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Berrino PM, Gatti M, Rotaru V, Bianchi L, Tumietto F, Sora E, Schiavina R, Brunocilla E, Viale P, Pea F. Efficacy of a Novel Prophylactic Scheme of Fosfomycin Trometamol in Patients Undergoing Endoscopic Surgery for Benign Prostatic Hyperplasia: Findings from a Prospective Monocentric Single-Arm Study. Antibiotics (Basel) 2024; 13:424. [PMID: 38786152 PMCID: PMC11117375 DOI: 10.3390/antibiotics13050424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 04/26/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
This study aimed to assess the efficacy of a novel prophylactic scheme of fosfomycin trometamol in patients undergoing elective HoLEP (holmium laser enucleation of the prostate) or TURP (transurethral resection of the prostate) procedures for treating benign prostatic hyperplasia. Patients affected by benign prostatic hyperplasia and undergoing elective HoLEP or TURP procedures during the period February 2022-June 2023 were prospectively enrolled. Two 3 g oral fosfomycin trometamol doses 12 h apart were administered at 8.00 p.m. on day -1 (i.e., the day before HoLEP or TURP procedure) and at 8.00 a.m. on day 0 (i.e., the day of the surgical procedure). The following outcomes were assessed: prevalence of fever occurring in the first 48 h after surgical procedure; prevalence of urological complications occurring after the surgical procedure; prevalence of proven urinary tract infections (UTIs) and/or bloodstream infections (BSIs) at 14 days post-procedure; and prevalence of emergency department admission for UTI-related sepsis at 14 days post-procedure. Univariate analysis comparing patients with and without proven UTI, BSI, or emergency department admission at 14 days post-procedure was carried out. Overall, 96 patients (median age 70 years) undergoing HoLEP (82.3%) or TURP (17.7%) were prospectively included. Median (IQR) time of surgical procedure after the morning fosfomycin dose was 226.5 min (range 88.5-393.75 min). Fever in the post-surgical 48 h occurred in 3/96 patients (3.1%). Prevalence of proven UTI at 14 days was as low as 1.0% (1/96), whereas no patient had proven BSI or UTI-related sepsis requiring emergency department admission at 14 days. Our findings support the contention that a prophylactic scheme based on two doses of fosfomycin trometamol 12 h apart before surgical intervention may represent a valuable strategy for preventing infectious complications in urologic patients undergoing HoLEP or TURP. Larger definitive confirmatory studies are warranted.
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Affiliation(s)
- Pasquale Maria Berrino
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy; (P.M.B.); (V.R.); (L.B.); (R.S.); (E.B.)
| | - Milo Gatti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (P.V.); (F.P.)
- Clinical Pharmacology Unit, Department for integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy
| | - Valeria Rotaru
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy; (P.M.B.); (V.R.); (L.B.); (R.S.); (E.B.)
| | - Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy; (P.M.B.); (V.R.); (L.B.); (R.S.); (E.B.)
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (P.V.); (F.P.)
| | - Fabio Tumietto
- Antimicrobical Stewardship Unit, Department for integrated Infectious Risk Management, Azienda USL of Bologna, 40138 Bologna, Italy; (F.T.); (E.S.)
| | - Elena Sora
- Antimicrobical Stewardship Unit, Department for integrated Infectious Risk Management, Azienda USL of Bologna, 40138 Bologna, Italy; (F.T.); (E.S.)
| | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy; (P.M.B.); (V.R.); (L.B.); (R.S.); (E.B.)
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (P.V.); (F.P.)
| | - Eugenio Brunocilla
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy; (P.M.B.); (V.R.); (L.B.); (R.S.); (E.B.)
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (P.V.); (F.P.)
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (P.V.); (F.P.)
- Infectious Disease Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (P.V.); (F.P.)
- Clinical Pharmacology Unit, Department for integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria of Bologna, 40138 Bologna, Italy
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Méndez‐Guerrero DM, Buitrago‐Carrascal C, Puentes‐Bernal AF, Cruz‐Arévalo DA, Camacho ‐Nieto D, Calderón MA, Álvarez‐Restrepo JC, Brijaldo‐Carvajal MA, Perdomo‐Bernal N, Moreno‐Matson MC, Ibañez‐Pinilla M, Daza‐Vergara J. Antibiotic prophylaxis in flexible ureterorenoscopy with negative urine culture. BJUI COMPASS 2023; 4:688-694. [PMID: 37818028 PMCID: PMC10560613 DOI: 10.1002/bco2.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/05/2023] [Accepted: 03/19/2023] [Indexed: 10/12/2023] Open
Abstract
Objective To improve susceptibility profiles of nosocomial bacteria, identifying the difference between infectious complications in patients undergoing endoscopic flexible ureterolithotomy (fURS) with negative urine culture (UC) that received extended antibiotic prophylaxis (EP) compared with standard antibiotic prophylaxis (SP). Methodology This is a retrospective, observational, analytical cohort study, comparing infectious complications between patients undergoing fURS with negative UC who received EP versus SP. We include patients with susccessfull fURS, <20-mm stones and complete information. Results Overall, 10.3% of patients had complications, 7.2% of patients had postoperative urinary infection, 1.8% had upper urinary tract infection (UTI) and 1.4% had urinary sepsis. Lower UTI were significantly more likely in the extended prophylaxis group with 6.8% versus 2.7% (RR = 2.8; 95% CI: 1.10-7.37, p = 0.030). The risk of upper UTI and sepsis did not show significant differences. A total of 69% patients with postoperative infection had isolated multidrug-resistant bacteria (MDRB) in the UC, with a higher risk in patients with extended prophylaxis (RR = 3.1; 95% CI: 1.33-7.59, p = 0.009). Conclusions Patients with negative UC who underwent fURS using extended prophylaxis have two times higher risk of low UTI than patients with standard prophylaxis, without differences in the incidence of upper UTI or urinary sepsis. The risk of MDRB isolation in the postoperative UC is higher in the extended prophylaxis group, therefore we recommend the standard 60-min preoperative prophylaxis.
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Affiliation(s)
| | | | | | | | - Diego Camacho ‐Nieto
- Department of UrologyHospital Universitario Mayor Méderi ‐ Universidad del RosarioBogotáColombia
| | | | | | | | | | | | | | - José Daza‐Vergara
- Hospital Universitario Mayor Méderi ‐ Universidad del RosarioBogotáColombia
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Panach-Navarrete J, Valls-González L, Sánchez-Cano E, Medina-González M, Castelló-Porcar A, Martínez-Jabaloyas JM. Comparison of three different antibiotic protocols in transurethral resection of bladder tumour and the possible infectious risk factors: A non-randomized, prospective study. Can Urol Assoc J 2018; 12:E466-E674. [PMID: 29989880 DOI: 10.5489/cuaj.5207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We sought to investigate three different antibiotic protocols in transurethral resection of a bladder tumour (TURBT), and the possible infectious risk factors of this surgery. METHODS We conducted a non-randomized, prospective study, gathering cases of patients in whom TURBT had been performed. The sample was divided into three groups based on those who received antibiotics as: a single preoperative dose (Group A); a preoperative dose, plus a long protocol during the hospitalization (Group B); a preoperative dose, plus a long protocol during the hospitalization, plus five days at home (Group C). Intra- and postoperative data that could be relevant to infections was gathered. RESULTS A total of 219 patients were included. In the multivariate analysis, it was observed that the patients in Group A were more prone to re-hospitalization due to fever than were those from Group C (odds ratio [OR] 11.13; p=0.03). Furthermore, the cases with tumour necrosis and those who entered surgery with a urinary catheter were more prone to have a temperature above 37.5°C (OR6.74; p=0.02 and OR6.4; p=0.04, respectively), as well as have an increased risk per every additional tumour in the cystoscopy (OR 1.32; p=0.01). Those who received mitomycin had a lower chance of a positive urine culture (OR 0.29; p=0.01), contrary to those patients with over two days of hospitalization (OR 4.11; p<0.01) and those who entered surgery with a urinary catheter (OR 12.35; p=0.02). CONCLUSIONS Those patients that only received a single dose of antibiotic before TURBT may have an increased risk of re-hospitalization due to fever in comparison to those who received prolonged antibiotic protocols. In addition, there are perioperative factors in this surgery that predict the risk of infectious complications.
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Affiliation(s)
- Jorge Panach-Navarrete
- Department of Urology, University Clinic Hospital of Valencia and Facultat de Medicina i Odontologia, Universitat de València, Valencia, Spain
| | - Lorena Valls-González
- Department of Urology, University Clinic Hospital of Valencia and Facultat de Medicina i Odontologia, Universitat de València, Valencia, Spain
| | - Eduardo Sánchez-Cano
- Department of Urology, University Clinic Hospital of Valencia and Facultat de Medicina i Odontologia, Universitat de València, Valencia, Spain
| | - María Medina-González
- Department of Urology, University Clinic Hospital of Valencia and Facultat de Medicina i Odontologia, Universitat de València, Valencia, Spain
| | - Ana Castelló-Porcar
- Department of Urology, University Clinic Hospital of Valencia and Facultat de Medicina i Odontologia, Universitat de València, Valencia, Spain
| | - José María Martínez-Jabaloyas
- Department of Urology, University Clinic Hospital of Valencia and Facultat de Medicina i Odontologia, Universitat de València, Valencia, Spain
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Sopeña-Sutil R, Medina-Polo J, Justo-Quintas J, Gil-Moradillo J, Garcia-Gonzalez L, Benítez-Sala R, Alonso-Isa M, Lara-Isla A, Tejido-Sanchez A. Healthcare-Associated Infections after Lower Urinary Tract Endoscopic Surgery: Analysis of Risk Factors, Associated Microorganisms and Patterns of Antibiotic Resistance. Urol Int 2018; 100:440-444. [PMID: 29649830 DOI: 10.1159/000488251] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 03/05/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To review the incidence of healthcare-associated infections/urinary tract infection (UTI), risk factors, microorganisms isolated and antibiotic resistances in patients who underwent lower urinary tract endoscopic surgery (LUTES) in a tertiary care hospital. METHODS A prospective observational study was carried out including 1,498 patients who undergo LUTES. Patients with and without UTI after surgery were compared. We analysed infection incidence, risk factors, microorganisms isolated and antibiotic resistances. RESULTS Postoperative UTI incidence was 4.7%. Risk factors found: higher American Society of Anesthesiologists classification (OR 2.82; 95% CI 1.8-4.5; p < 0.00), immunosuppression (OR 2.89; 95% CI 1.2-7.2; p = 0.01), indwelling urinary catheter prior admission (OR 2.6; 95% CI 1.6-4.2; p < 0.00) and postoperative catheterization longer than 2 days (OR 1.74; 95% CI 1.7-4.3; p < 0.00). Transurethral resection of the bladder (TURB) had the highest infection rates (5.5%). Microorganisms isolated were Pseudomonas aeruginosa (23.5%), Escherichia coli (17.6%), Klebsiella pneumoniae and Enterococcus spp (11.8%). Resistance rates for flourquinolones varied between 28 and 80%, and Carbapenem-resistant Enterobacteriaceae rose up 20%. CONCLUSIONS Low percentage of UTI after endoscopic surgery was registered. TURB was the procedure with highest infection rate. Pseudomonas aeruginosa stands out as the most frequently isolated microorganism. Patient comorbidities, previous urinary catheter and postoperative catheter were identified as risk factors.
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