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Abstract
Despite the high level of safety and low incidence of mortality associated with transurethral
resection of the prostate (TURP), urinary tract infections (UTIs)—the most common
complication associated with this procedure—continue to be an important source of
postoperative morbidity and costs. However, there is controversy about whether antimicrobial
agents should be used as UTI prophylaxis in patients undergoing TURP and, if so, which
agents should be used and for what duration. This retrospective study used multivariate
regression analysis to evaluate the different types and durations of antibiotic prophylaxis
in 222 patients who underwent TURP at a Veterans Affairs hospital between January
1, 1995, and March 30, 1998. The primary outcome measures were total medical costs
(ie, medication use, clinic office visits, and hospital care in the 4 weeks after
the procedure), length of hospital stay (total days in hospital due to the procedure),
and probability of UTI (incidence of infection in the 4 weeks after the procedure).
Results showed that there was no difference in the length of hospital stay regardless
of the regimen or duration of pre-TURP antibiotic therapy. Patients who received pre-TURP
ampicillin plus ceftizoxime incurred moderately higher total medical costs than did
patients who received the least costly drug, cefazolin (P = 0.10). Similarly, patients who received postTURP quinolones incurred a significantly
higher total medical cost than did patients who received co-trimoxazole (P = 0.06). We found no evidence of a relationship between use of specific parenteral
or oral antibiotic prophylaxis for UTI in patients undergoing TURP and the rate of
UTI in such patients. Thus there is no justification for the use of more expensive
antibiotic regimens. At our institution, the preferred pre-TURP prophylactic regimen
would be cefazolin, whereas co-trimoxazole would be the most cost-effective post-TURP
prophylactic regimen. Because duration of post-TURP prophylaxis does not appear to
influence the rate of UTI, 24 hours would seem adequate.
Key words
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Article info
Publication history
Accepted:
March 26,
1999
Identification
Copyright
© 1999 Published by Elsevier Inc.
