Single-dose infection prophylaxis effective in urologic surgery
medwireNews: Researchers in Japan have shown that a single dose of antimicrobial prophylaxis prior to some urologic procedures results in low rates of perioperative infection.
The team, led by Yoshikazu Togo (Hyogo College of Medicine), says that the findings could help align Japanese guidelines with those for European and US urologic surgeons, which advocate more prudent antibiotic use.
The team analyzed the outcomes of 4677 low-to-intermediate risk patients (American Society of Anesthesiologists [ASA] score 1–3) undergoing urologic surgery during 2010. Overall, there were 2507 endourologic, 1276 clean, 807 clean-contaminated, and 87 contaminated surgical procedures.
All patients, except those undergoing contaminated procedures, transurethral resection of the prostate or percutaneous nephrolithotripsy, received a single dose of antimicrobial prophylaxis, with an additional administration during surgery if the procedure lasted longer than 3 hours.
The researchers observed low rates of perioperative infections in patients undergoing endourologic procedures, with remote infection and urinary tract infection (UTI) rates of just 0% and 4%, respectively.
In clean surgery, rates of surgical site infection (SSI), UTI, and remote infection were all 1%, with corresponding rates of 3%, 3%, and 2% for clean-contaminated procedures. In contaminated procedures involving bowel segments, rates were higher at 17%, 30%, and 10%, respectively.
The team found that there were no risk factors significantly associated with perioperative infection in clean-contaminated or contaminated surgery, but operative time was significantly associated with the risk for UTI in endourologic surgery such that it increased by 58% for each additional hour. ASA score and operative time were also significant risk factors for remote infections in clean surgery, with a 4.26-fold greater odds for patients with an ASA of 3 compared with those with lower scores, and a 1.46-fold increased odds for every extra hour in the operating room.
Guidelines issued by the Japanese Urological Association generally recommend longer antimicrobial prophylaxis than those of the European and American Urological Associations, explain the authors in the Journal of Infection and Chemotherapy.
However, longer durations of antibiotics are associated with the induction of resistant bacteria, which means that prolonged administration should be avoided, they say.
Togo and team conclude that their results show that in endourologic, clean, and clean-contaminated procedures, a single-dose regimen is effective, and they suggest it may even be appropriate in some contaminated procedures, dependent on the outcomes of future studies.
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By Kirsty Oswald, medwireNews Reporter