title: Assessment of a protocol for prophylactic antibiotics to prevent perioperative infection in urological surgery: a preliminary study.
abstract: BACKGROUND
  The aim of the present study was to assess the usability and efficacy of our new protocol of prophylactic antibiotic use to prevent perioperative infection in urological surgery.
  
  
  METHODS
  We prospectively investigated 339 cases of typical urological surgery in our department between April 2001 and March 2002 (group I). We classified surgical procedures into four categories by invasiveness and contamination levels: category A, clean less invasive or endoscopic surgery; category B, clean invasive or clean contaminated surgery; category C, urinary tract diversion using the intestine; and category D, infected surgery. Antibiotics were administrated intravenously according to our protocol: category A, first or second generation cephems or penicillins during the operative day only; category B, first and second generation cephems or penicillins for 3 days; and category C, second or third generation cephems for 4 days. Category D was excluded from the analysis. To judge perioperative infections, the wound condition and general conditions were evaluated in terms of the surgical site infection (SSI) as well as remote infection (RI) up to postoperative day (POD) 14. We retrospectively reviewed 308 patients who underwent urological surgery between April 2000 and March 2001 (group II) as reference cases that were administered antibiotics without any restriction.
  
  
  RESULTS
  Perioperative infection rates (SSI + RI) in group I and group II were 25 of 339 (7.4%) and 35 of 308 (11.4%), respectively. Surgical site infection rates of categories A, B, and C in group I were 1.8%, 7.6%, and 30.0%, respectively, while those in group II were 2.0%, 7.4%, and 46.2%, respectively. There was no significant difference in infection rates in terms of RI and SSI between group I and group II. The amounts, as well as the prices, for intravenously administrated antibiotics and oral antibiotics decreased to approximately half and one-fifth, respectively.
  
  
  CONCLUSIONS
  Our protocol effectively decreased the amount of antibiotics used without increasing perioperative infection rates. Thus, our protocol of prophylactic antibiotic therapy would be recommended as an appropriate method for preventing perioperative infection in urological surgery.
authors.affiliation: Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Sojun
authors.initials: S
authors.lastname: Kanamaru
authors.forename: Akito
authors.initials: A
authors.lastname: Terai
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ishitoya
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Kunishima
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nishiyama
authors.forename: Takehiko
authors.initials: T
authors.lastname: Segawa
authors.forename: Eijiro
authors.initials: E
authors.lastname: Nakamura
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Kinoshita
authors.forename: Seiji
authors.initials: S
authors.lastname: Moroi
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Ito
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kamoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Okuno
authors.forename: Tomonori
authors.initials: T
authors.lastname: Habuchi
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Senda
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ichiyama
authors.forename: Osamu
authors.initials: O
authors.lastname: Ogawa
authors.forename: Shingo
authors.initials: S
authors.lastname: Yamamoto
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002511:Cephalosporins / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D007223:Infant; D007262:Infusions, Intravenous; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010406:Penicillins / Q000627:therapeutic use*; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control*; D013520:Urologic Surgical Procedures
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D010406:Penicillins