Assessment of a protocol for prophylactic antibiotics to prevent perioperative infection in urological surgery: a preliminary study.
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.
Kanamaru
Sojun
S
Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Terai
Akito
A
Ishitoya
Satoshi
S
Kunishima
Yasuharu
Y
Nishiyama
Hiroyuki
H
Segawa
Takehiko
T
Nakamura
Eijiro
E
Kinoshita
Hidefumi
H
Moroi
Seiji
S
Ito
Noriyuki
N
Kamoto
Toshiyuki
T
Okuno
Hiroshi
H
Habuchi
Tomonori
T
Senda
Kazuyoshi
K
Ichiyama
Satoshi
S
Ogawa
Osamu
O
Yamamoto
Shingo
S
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
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D010406:Penicillins