title: [A multi-center prospective study for antibiotic prophylaxis to prevent perioperative infections in urologic surgery].
abstract: In order to assess the ability of our protocol for antibiotic prophylaxis to prevent perioperative infections in urologic surgery, 1,353 operations of open and laparoscopic urologic surgery conducted in 21 hospitals between September 2002 and August 2003 were subjected to analyses. We classified surgical procedures into four categories by invasiveness and contamination levels: Category A; clean less invasive surgery, Category B; clean invasive or clean-contaminated surgery, Category C; surgery with urinary tract diversion using the intestine. Prophylactic antibiotics were administrated intravenously according to our protocol, such as Category A; first or second generation cephems or penicillins on the operative day only, Category B; first and second generation cephems or penicillins for 3 days, and Category C; first, second or third generation cephems or penicillins for 4 days. The wound conditions and general conditions were evaluated in terms of the surgical site infection (SSI) as well as remote infection (RI) up to postoperative day (POD) 30. The SSI rate highest (23.3%) for surgery with intestinal urinary diversion, followed by 10.0% for surgery for lower urinary tract, 8.9% for nephroureterctomy, and 6.0% for radical prostatectomy. The SSI rates in clean surgery including open and laparoscopic nephrectomy/adrenalectomy were 0.7 and 1.4%, respectively. In SSIs, gram-positive cocci such as methicillin-resistant Staphylococcus aureus (58.8%) or Enterobacter faecalis (26.5%) were the most common pathogen. Similarly, the RI rate was the highest (35.2%) for surgery using intestinal urinary diversion, followed by 16.7% for surgery for lower urinary tract, 11.4% for nephroureterctomy, and 7.6% for radical prostatectomy, while RI rates for clean surgery were less than 5%. RIs most frequently reported were urinary tract infections (2.6%) where Pseudomonas aeruginosa (20.3%) and Enterobacter faecalis (15.3%) were the major causative microorganisms. Parameters such as age, obesity, nutritional status (low proteinemia), diabetes mellitus, lung disease, duration of operation, and blood loss volume were recognized as risk factors for SSI or RI in several operative procedures. Postoperative body temperatures, peripheral white blood counts, C reactive protein (CRP) levels in POD 3 were much higher than those in POD 2 in cases suffering from perioperative infections, especially suggesting that CRP could be a predictable marker for perioperative infections.
authors.affiliation: Department of Urology, Graduate School of Medicine, Kyoto University.
authors.forename: Shingo
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Kunishima
authors.forename: Sojun
authors.initials: S
authors.lastname: Kanamaru
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Ito
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Kinoshita
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kamoto
authors.forename: Osamu
authors.initials: O
authors.lastname: Ogawa
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Arai
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Okumura
authors.forename: Toshiro
authors.initials: T
authors.lastname: Terachi
authors.forename: Seiji
authors.initials: S
authors.lastname: Moroi
authors.forename: Yusaku
authors.initials: Y
authors.lastname: Okada
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Nishio
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kanamaru
authors.forename: Masashi
authors.initials: M
authors.lastname: Inui
authors.forename: Akira
authors.initials: A
authors.lastname: Asazuma
authors.forename: Isao
authors.initials: I
authors.lastname: Kanatani
authors.forename: Miharu
authors.initials: M
authors.lastname: Sasaki
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Nishikawa
authors.forename: Shuichi
authors.initials: S
authors.lastname: Hida
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Nonomura
authors.forename: Akito
authors.initials: A
authors.lastname: Terai
authors.forename: Keiji
authors.initials: K
authors.lastname: Ogura
authors.forename: Kenji
authors.initials: K
authors.lastname: Mitsumori
authors.forename: Kazuo
authors.initials: K
authors.lastname: Nishimura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Onishi
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Horii
authors.forename: Toshinari
authors.initials: T
authors.lastname: Yamasaki
mesh_terms: D019072:Antibiotic Prophylaxis / Q000379:methods*; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D010406:Penicillins / Q000627:therapeutic use; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data; D012308:Risk Management; D013530:Surgical Wound Infection / Q000517:prevention & control*; D014547:Urinary Diversion; D013520:Urologic Surgical Procedures
chemical_list: D010406:Penicillins