Belgium: Study on Antimicrobial Prophylaxis in TURP

Antimicrobial prophylaxis can be safely omitted in patients undergoing transurethral resection of the prostate (TURP) without a preoperative indwelling catheter and pyuria, finds a recent study. The findings are published in The Journal of Urology.

Transurethral resection of the prostate is a surgery used for the treatment of urinary problems caused by an enlarged prostate. The procedure involves the insertion of an instrument called a resectoscope through the tip of the penis into the urethra. The resectoscope helps to examine and trim away excess prostate tissue causing the blockage to urinary flow. It is considered as an option for patients having moderate to severe urinary problems that haven't responded to medication.

Antibiotic prophylaxis is standard procedure in TURP. It is used widely to protect patients from infectious complications of invasive procedures, including surgical site infections (SSIs). However, there has been a growing trend to minimize antibiotic usage to reduce the development of resistance from overuse.

Evert Baten, Associatie Urologie Hageland, Tielt-Winge, Belgium, and colleagues sought to determine whether omitting antimicrobial prophylaxis is safe in patients undergoing transurethral resection of the prostate without preoperative pyuria and a preoperative catheter.

For this purpose, the researchers conducted a multicenter randomized controlled trial from September 17, 2017, until December 31, 2019, in 5 hospitals. It excluded patients with pyuria (>100 white blood cells/ml) and a preoperative indwelling catheter.

Postoperative fever was defined as a body temperature ≥38.3°C. A noninferiority design was used with a 6% noninferiority margin and null hypothesis (H0) that the infection risk is at least 6% higher in the experimental (E) than in the control (C) group; H0: C (antimicrobial prophylaxis group) − E (no antimicrobial prophylaxis group) ≥ Δ (6% noninferiority margin).

Key findings of the study include:

• Of the patients, 474 were included for multivariable analysis and 44.5% received antimicrobial prophylaxis vs 55.5% patients without antimicrobial prophylaxis.
• Antibiotics were fluoroquinolones in 66.4% patients, cephazolin in 27.5%, and amikacin in 6.2% patients.
• Fever occurred in 4.4% patients with antimicrobial prophylaxis vs 4.9% without antimicrobial prophylaxis.
• The researchers were able to exclude a meaningful increase in harm associated with omitting antimicrobial prophylaxis.

"Our data demonstrate the safety of omitting antimicrobial prophylaxis in patients undergoing transurethral resection of the prostate without preoperative pyuria and a preoperative indwelling catheter," concluded the authors.

Reference:

The study titled, "Antimicrobial Prophylaxis in Transurethral Resection of the Prostate: Results of a Randomized Trial," is published in The Journal of Urology.

DOI: https://www.auajournals.org/doi/10.1097/JU.0000000000001638