Antibiotic prophylaxis for transurethral urological surgeries: Systematic review
The use of antibiotic prophylaxis to prevent urinary tract infection and bacteremia (sepsis) following endoscopic urologic procedures is a controversial topic. Evidence in the literature revealed that urological instrumentation is associated with increased incidence of urinary tract infection and ba...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2013-01-01
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| Series: | Urology Annals |
| Subjects: | |
| Online Access: | http://www.urologyannals.com/article.asp?issn=0974-7796;year=2013;volume=5;issue=2;spage=61;epage=74;aulast=Alsaywid |
| _version_ | 1811240335187116032 |
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| author | Basim S Alsaywid Grahame H. H. Smith |
| author_facet | Basim S Alsaywid Grahame H. H. Smith |
| author_sort | Basim S Alsaywid |
| collection | DOAJ |
| description | The use of antibiotic prophylaxis to prevent urinary tract infection and bacteremia (sepsis) following endoscopic urologic procedures is a controversial topic. Evidence in the literature revealed that urological instrumentation is associated with increased incidence of urinary tract infection and bacteremia. The aim of this review is to evaluate the effectiveness of antibiotic prophylaxis in reducing the risk of urinary tract infection in patients who had transurethral urological surgeries. We have selected all RCTs of adult population who underwent all different types of transurethral urological surgery, including cystoscopy, transurethral resection of prostate and transurethral resection of bladder tumor, and received prophylactic antibiotics or placebo/no treatment. At first, more than 3000 references were identified and reviewed; of which 42 studies with a total of 7496 patients were included in the final analysis. All those trials were analyzing antibiotic prophylaxis versus placebo/no treatment, and they were significantly favoring antibiotic use in reducing all outcomes, including bacteriuria (RR 0.36, 95% CI 0.29 to 0.46, P < 0.0001) with moderate heterogeneity detected (I 2 48%), symptomatic UTI (RR 0.38, 95% CI 0.28 to 0.51, P < 0.0001) with no significant heterogeneity was detected (I 2 = 17%), bacteremia (RR 0.43, 95% CI 0.23 to 0.82, P < 0.0001) with no noted heterogeneity (I 2 = 0%), and fever ≥38.5 Celsius (RR 0.41, 95% CI 0.23 to 0.73, P = 0.003); also, there was no noted heterogeneity (I 2 = 0%). However, using antibiotic prophylaxis did not reduce the incidence of low grade temperature (RR 0.82, 95% CI 0.61 to 1.11, P = 0.20) or in moderate grade temperature (RR 1.03, 95% CI 0.71 to 1.48, P = 0.89). Antibiotic prophylaxis appears to be an effective intervention in preventing urinary tract infections and its sequels following transurethral urological surgeries in patients with preoperative sterile urine. |
| first_indexed | 2024-04-12T13:17:15Z |
| format | Article |
| id | doaj.art-51787e755b594aba8a68b59a33179347 |
| institution | Directory Open Access Journal |
| issn | 0974-7796 0974-7834 |
| language | English |
| last_indexed | 2024-04-12T13:17:15Z |
| publishDate | 2013-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Urology Annals |
| spelling | doaj.art-51787e755b594aba8a68b59a331793472022-12-22T03:31:37ZengWolters Kluwer Medknow PublicationsUrology Annals0974-77960974-78342013-01-0152617410.4103/0974-7796.109993Antibiotic prophylaxis for transurethral urological surgeries: Systematic reviewBasim S AlsaywidGrahame H. H. SmithThe use of antibiotic prophylaxis to prevent urinary tract infection and bacteremia (sepsis) following endoscopic urologic procedures is a controversial topic. Evidence in the literature revealed that urological instrumentation is associated with increased incidence of urinary tract infection and bacteremia. The aim of this review is to evaluate the effectiveness of antibiotic prophylaxis in reducing the risk of urinary tract infection in patients who had transurethral urological surgeries. We have selected all RCTs of adult population who underwent all different types of transurethral urological surgery, including cystoscopy, transurethral resection of prostate and transurethral resection of bladder tumor, and received prophylactic antibiotics or placebo/no treatment. At first, more than 3000 references were identified and reviewed; of which 42 studies with a total of 7496 patients were included in the final analysis. All those trials were analyzing antibiotic prophylaxis versus placebo/no treatment, and they were significantly favoring antibiotic use in reducing all outcomes, including bacteriuria (RR 0.36, 95% CI 0.29 to 0.46, P < 0.0001) with moderate heterogeneity detected (I 2 48%), symptomatic UTI (RR 0.38, 95% CI 0.28 to 0.51, P < 0.0001) with no significant heterogeneity was detected (I 2 = 17%), bacteremia (RR 0.43, 95% CI 0.23 to 0.82, P < 0.0001) with no noted heterogeneity (I 2 = 0%), and fever ≥38.5 Celsius (RR 0.41, 95% CI 0.23 to 0.73, P = 0.003); also, there was no noted heterogeneity (I 2 = 0%). However, using antibiotic prophylaxis did not reduce the incidence of low grade temperature (RR 0.82, 95% CI 0.61 to 1.11, P = 0.20) or in moderate grade temperature (RR 1.03, 95% CI 0.71 to 1.48, P = 0.89). Antibiotic prophylaxis appears to be an effective intervention in preventing urinary tract infections and its sequels following transurethral urological surgeries in patients with preoperative sterile urine.http://www.urologyannals.com/article.asp?issn=0974-7796;year=2013;volume=5;issue=2;spage=61;epage=74;aulast=AlsaywidAntibiotic prophylaxisurinary tract infectionendourologybacteremia |
| spellingShingle | Basim S Alsaywid Grahame H. H. Smith Antibiotic prophylaxis for transurethral urological surgeries: Systematic review Urology Annals Antibiotic prophylaxis urinary tract infection endourology bacteremia |
| title | Antibiotic prophylaxis for transurethral urological surgeries: Systematic review |
| title_full | Antibiotic prophylaxis for transurethral urological surgeries: Systematic review |
| title_fullStr | Antibiotic prophylaxis for transurethral urological surgeries: Systematic review |
| title_full_unstemmed | Antibiotic prophylaxis for transurethral urological surgeries: Systematic review |
| title_short | Antibiotic prophylaxis for transurethral urological surgeries: Systematic review |
| title_sort | antibiotic prophylaxis for transurethral urological surgeries systematic review |
| topic | Antibiotic prophylaxis urinary tract infection endourology bacteremia |
| url | http://www.urologyannals.com/article.asp?issn=0974-7796;year=2013;volume=5;issue=2;spage=61;epage=74;aulast=Alsaywid |
| work_keys_str_mv | AT basimsalsaywid antibioticprophylaxisfortransurethralurologicalsurgeriessystematicreview AT grahamehhsmith antibioticprophylaxisfortransurethralurologicalsurgeriessystematicreview |