Prospective assessment of the efficacy of the EAU guidelines for the prevention of nosocomial acquired infections after genitourinary surgery in a district hospital.

OBJECTIVES: To evaluate incidence and risk factors for nosocomial acquired infections in an urology ward after the application of the European Association of Urology (EAU) guidelines for surgical prophylaxis after genitourinary surgery in a district hospital. METHODS: A three-month survey was performed according with the definitions and methods of the National Nosocomial Infections Surveillance System. The study was conducted at the Urology Unit of a district hospital of about 800 care beds. The unit has 24 beds with approximately 1000 patients admitted per year and 750 surgical procedures performed each year. During the study period antimicrobial prophylaxis was administered according to 2006 EAU Guidelines. The following events by CDC criteria were considered: site specific infection (SSI), symptomatic urinary tract infection (SUTI), other infection of urinary tract (OUTI) and blood stream infection (BSI). RESULTS: SUTI incidence density was 31/1000 patients-days and 34/1000 urinary catheter days. SSI and BSI incidence density were respectively 44/1000 and 25/1000 patients day. A total of 177 patients (146 M, 32 F) underwent surgical procedures (17 renal surgeries, 12 retropubic radical prostatectomies, 11 prostatectomies for benign prostatic hyperplasia, 9 cystectomies (with ileal neobladder or external urinary diversion respectively in 3 and 6), 19 male genital surgeries, 21 ureterorenoscopies (with/without lithotripsy), 10 ureteral catheterizations or stenting, 6 nephrostomies, 17 TURP, 50 TURB and 5 other procedures). Perioperative antibiotic prophylaxis was administered as a single dose of cefazolin 2 gr i.v. (or as an association of gentamicin and ampicillin) in 92 patients (51%). Nine patients with positive urine culture were treated with antibiotics prior to treatment (5%) and 40 patients were treated postoperatively (22%). After surgery UTI was diagnosed in 6 patients, SSI in 3 and BSI in 11. Risk factors for infection were indwelling catheter in 22, previous history of UTI in 15, long pre operative hospital stay in 2, diabetes in 24 patients. CONCLUSIONS: Antimicrobial prophylaxis according to EAU guidelines together with an active surveillance seems to be adequate to prevent symptomatic/febrile genito-urinary infections as well as serious wound infections in the majority of patients. A further effort should be made in order to identify sub-populations of patients for which the actual prophylactic regimen proved to be less efficacious.