This paper is only available as a PDF. To read, Please Download here.
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Clinical Therapeutics
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Benign Prostatic Hyperplasia: Diagnosis and Treatment. AHCPR Guideline 94-0582. Agency for Health Care Policy and Research, Silver Spring, MdFebruary 1994
- Antimicrobial prophylaxis in transurethral surgery.Urology. 1990; 35 (Suppl): 11-14
- Antimicrobial agents in transurethral prostatic resection.J Urol. 1987; 138: 245-252
- European Collaborative Study of Antibiotic Prophylaxis for Transurethral Resec tion of the Prostate.Eur Urol. 1993; 23: 437-443
- Septicemia after transurethral prostatectomy.Urology. 1993; 12: 133-135
- Systemic antibi otics for prophylaxis in urologic surgery: A critical review.J Urol. 1979; 121 (Abstract): 695
- Antimicrobial prophylaxis in transurethral surgery.Infection. 1986; 14 (Abstract): 201
- Perioperative antibiotic prophylaxis for transurethral resection of the prostate: Is it justifiable?.J Urol. 1989; 142: 317-319
- Is antibiotic prophylaxis worthwhile in patients with transurethral resection of prostate?.Urology. 1982; 19: 43-46
- Transurethral prostatectomy: Immediate, postoperative complications. A cooperative study of 13 participating institutions evaluating 3,885 patients.J Urol. 1989; 141 (Abstract): 243
- Urinary tract infections following laser prostatectomy: Is there a need for antibiotic prophylaxis?.Br J Urol. 1996; 77: 228-232
- 48-Hour cephradine and post-prostatectomy bacteriuria.Br J Urol. 1980; 52: 311-315
- Controlled trial of a short and a prolonged course with ciprofloxacin in patients undergoing transurethral resection of the prostate.Eur J Clin Microbiol Infect Dis. 1987; 6: 11-17
- Antibiotic prophylaxis for patients undergoing transurethral resection of the prostate.Adult Urol. 1996; 47: 852-856
- Prophylaxis antimicrobial treatment in transurethral prostatectomy. How long should it be instituted?.Urology. 1983; 22: 136-138
- Oral fleroxacin prophylaxis in transurethral surgery.J Urol. 1996; 156: 146-148
- Prevention of urinary tract infection and bacteremia following transurethral surgery: Oral lomefloxacin compared to parenteral cefotaxime.J Urol. 1992; 147: 1053-1055
- Ceftriaxone in the prevention of postoperative infection in patients undergoing transurethral resection of the prostate.Am J Surg. 1994; : 19-21
- Short-term prophylaxis with ce-fotaxime for prostatic surgery.Br Med J. 1982; 284: 1008-1010
- Short-term cephalosporin prophylaxis in transurethral surgery.Clin Ther. 1982; 5: 58-66
- General guidelines for the evaluation of new anti-infective drugs for prophylaxis of surgical infections.Clin Infect Dis. 1992; 15: S313-S338
- Use of antimicrobial drugs in general hospitals.N Engl J Med. 1979; 361: 351-355
- Does more intensive treatment of acute myocardial infarction in the elderly reduce mortality?.JAMA. 1994; 11: 859-866
- Who is the marginal patient? Understanding instrumental variables estimates of treatment effects.Health Serv Res. 1998; 33: 1337-1360
Accepted: March 26, 1999
© 1999 Published by Elsevier Inc.