Antimicrobial Prophylaxis in Transurethral Resection of the Prostate: Results of a Randomized Trial.
J Urol
; 205(6): 1748-1754, 2021 Jun.
Article
em En
| MEDLINE
| ID: mdl-33560163
ABSTRACT
PURPOSE:
We sought to determine whether omitting antimicrobial prophylaxis is safe in patients undergoing transurethral resection of the prostate without preoperative pyuria and a preoperative catheter. MATERIALS ANDMETHODS:
We conducted a multicenter randomized controlled trial from September 17, 2017 until December 31, 2019 in 5 hospitals. Patients with pyuria (>100 white blood cells/ml) and a preoperative indwelling catheter were excluded. Postoperative fever was defined as a body temperature ≥38.3C. 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). A multivariable, logistic regression was performed regarding posttransurethral resection of the prostate fever and antimicrobial prophylaxis with co-variates (clot-)retention and operating time. The R Project® for statistical computing was used and a p value of 0.05 was considered as statistically significant.RESULTS:
Of the patients 474 were included for multivariable analysis and 211/474 (44.5%) received antimicrobial prophylaxis vs 263/474 (55.5%) patients without antimicrobial prophylaxis. Antibiotics were fluoroquinolones in 140/211 (66.4%), cephazolin in 58/211 (27.5%) and amikacin in 13/211 (6.2%) patients. Fever occurred in 9/211 (4.4%) patients with antimicrobial prophylaxis vs 13/263 (4.9%) without antimicrobial prophylaxis (p=0.8, risk difference 0.006 [95% CI -0.003-0.06, relative risk 1.16]). We were able to exclude a meaningful increase in harm associated with omitting antimicrobial prophylaxis (p=0.4; adjusted risk difference 0.016 [95% CI -0.02-0.05]).CONCLUSIONS:
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
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Infecções Urinárias
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Amicacina
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Cefazolina
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Antibioticoprofilaxia
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Ressecção Transuretral da Próstata
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Fluoroquinolonas
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Antibacterianos
Tipo de estudo:
Clinical_trials
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Etiology_studies
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Observational_studies
Limite:
Aged
/
Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Urol
Ano de publicação:
2021
Tipo de documento:
Article
País de afiliação:
Bélgica