Antimicrobial prophylaxis in urologic surgery: does it give some benefit?
Three types of antibiotic prophylactic regimens were evaluated versus a control without prophylaxis (group A: 3,912 cases) in urologic surgery. The antibiotic regimens were: group B = cefazolin 1 g/12 h/3 days (3,660 cases); group C = cefonicid 1 g/24 h/3 days (2,076 cases), and group D = cefonicid 1 g single dose (3,169 cases). The parameters used were the comparison of the corresponding rates of postsurgical sepsis and operative wound infections. Numeric investigations for the validity of a retrospective study (unpaired data) were performed: homogenicity test, relative risk point estimate and confidence limits (95%), and etiological fraction point estimate and confidence limits (95%). Chi-square for other purposes were performed. Endoscopic handling was considered homogeneous (same infective risk), while open surgery was heterogeneous (p < 0.001). In order to avoid probable bias, a correction factor was used. Although in different degrees, prophylaxis significantly reduced the morbidity of surgical wound infections (p < 0.001; etiological fraction > 90%). The differences (p < 0.01) between groups B and C/D were attributed to pharmacokinetic causes (short T 1/2 of cefazolin). To obtain the maximum protective effect, the use of antibiotics with a T 1/2 of > 4 h is suggested. There was no resistant mutans in previously sensitive strains. However, a significant selection of intrinsically resistant strains was observed. Monodose offers at lest the same advantages as multiple-dose therapy. In addition, the monodose selected in a lesser proportion both the resistant strains (p < 0.001) and the number of microbial associations (p < 0.01).
del Rio
G
G
Department of Nephrology, Institute of Urology, Nephrology and Andrology, Barcelona, Spain.
Dalet
F
F
Chechile
G
G
D002437:Cefazolin / Q000008:administration & dosage*; D015790:Cefonicid / Q000008:administration & dosage*; D016001:Confidence Intervals; D015653:Cystectomy; D006801:Humans; D007668:Kidney / Q000601:surgery; D016030:Kidney Transplantation; D011292:Premedication; D012189:Retrospective Studies; D012772:Shock, Septic / Q000382:microbiology / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control; D014513:Ureter / Q000601:surgery; D014551:Urinary Tract / Q000601:surgery*
D015790:Cefonicid; D002437:Cefazolin