A randomized and prospective study on the value of antibiotic prophylaxis administration in transurethral resection of the prostate.
BACKGROUND
Antibiotic prophylaxis in transurethral resection of the prostate is a regular practice in urology. However, its prophylactic effect can be questioned when the antiseptic surgical technique is used. Nonetheless, urine culture-oriented antibiotic therapy is the gold standard for avoiding improper medication usage and bacterial resistance.


OBJECTIVE
To study the efficacy of antibiotic usage in patients with negative urine cultures, who were submitted to transurethral resection of the prostate.


METHODS
Prospective open labeled study.


METHODS
Tertiary care referral hospital.


METHODS
124 consecutive patients, who were randomly divided into two groups to receive antibiotic prophylaxis or not.


METHODS
Cultures from meatus, urine, irrigation and antiseptic fluid, and prostate tissue chips, were compared and analyzed for bacterial sensitivity to the antibiotic used, according to the surgeon's personal criteria. McLennan's test was used for statistical analysis.


RESULTS
No statistically significant difference regarding clinical evolution was found between the groups that received or antibiotics or not. Statistical significance was found regarding the occurrence of positive urine cultures during the postoperative period for those not receiving antibiotics, but not in relation to fever, prostate chip culture or bacteremic episodes. Sixty-eight subjects (57.1%) presented positive prostatic tissue culture. There was no specific correlation between the recovered bacteria from the meatus, prostatic tissue chip and urine and the spectrum of the administered antibiotic. Six cases showed the same bacteria in the urine and prostatic tissue chip. Only fifteen cases (25%) in the antibiotic group showed the desired sensitivity directed to the collected bacteria.


CONCLUSIONS
Antibiotic prophylaxis for patients whose urine is sterile is debatable in patients who are candidates for transurethral resection of the prostate. Most of the time, the antibiotic agent used is not specific for any of the bacteria recovered from the various sources analyzed.
Rodrigues
Paulo
P
Urology and Nephrology Clinic, Neurourology and Voiding Disturbances Section, Hospital Beneficência Portuguesa, São Paulo, Brazil. Paulortrodrigues@aol.com
Hering
Flávio
F
Meller
Alex
A
Campagnari
João Carlos
JC
D'Império
Márcio
M
D000368:Aged; D019072:Antibiotic Prophylaxis; D016470:Bacteremia / Q000382:microbiology / Q000517:prevention & control; D001437:Bacteriuria / Q000382:microbiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011472:Prostatitis / Q000382:microbiology / Q000517:prevention & control; D020728:Transurethral Resection of Prostate