Perioperative antibiotics for transurethral resection of prostate in indwelling catheter dependence
Dhanika Samaranayake1, Trent Pattenden1, Morton Andrew1, Jonathan Chambers1.
1Department of Urology, Ipswich Hosptial, Queensland, Australia
Introduction: The literature suggests that having an indwelling catheter (IDC) prior to transurethral resection of the prostate (TURP) is closely associated with an increased risk of postoperative urinary tract infection (UTI). Although guidelines strongly recommend antibiotic prophylaxis for TURP, the use of antibiotic prophylaxis in patients with preoperative IDC remains unclear.1 The aim of this study was to retrospectively evaluate preoperative antimicrobial therapy in patients undergoing TURP for IDC dependence and post-operative UTI outcomes.
Methods: A retrospective chart review of 53 patients undergoing TURP was performed. Electronic medical records of these patients were reviewed for IDC dependence, preoperative UTI, preoperative antimicrobial management, and 30-day admissions with UTI. Exclusion criteria were any additional procedures at the time of the TURP and postoperative IDC for >7 days.
Results: Out of the 53 charts reviewed, three patients were excluded for IDC >7 days and additional procedures. The mean age was 68 years. Preoperative IDC was present in 24 patients. Positive preoperative culture was found in 83% of IDC-dependent patients and 80% were treated with oral antibiotics (Abs). IV Abs in the 24 hours prior to surgery was given to 79% of IDC-dependent cases, along with a change of catheter. All patients received an induction dose of IV Abs; only two patients received induction IV Abs alone. Readmission with UTI within 30 days was 16% in IDC-dependent patients receiving preoperative IV Abs compared to 20% with no IV Abs (p=0.82). Choices of IV Abs used on induction for IDC-dependent TURP is shown in Figure 1, illustrating significant variability.
Conclusions: Patients with an IDC prior to undergoing a TURP have a significantly high incidence of culture-proven UTIs. Preoperative intravenous Abs and IDC change prior to a TURP could reduce their risk of readmission. There is also significant variability in the choice of Abs used during induction. More research is warranted in this area to establish clear guidelines.
[1] Lawson K, Rudzinski J, et al. Assessment of antibiotic prophylaxis prescribing patterns for TURP: A need for Canadian guidelines? Can Urol Assoc J 2013;7(7-8):e530-6.
