[A multi-center prospective study for antibiotic prophylaxis to prevent perioperative infections in urologic surgery].
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.
Yamamoto
Shingo
S
Department of Urology, Graduate School of Medicine, Kyoto University.
Kunishima
Yasuharu
Y
Kanamaru
Sojun
S
Ito
Noriyuki
N
Kinoshita
Hidefumi
H
Kamoto
Toshiyuki
T
Ogawa
Osamu
O
Arai
Yoichi
Y
Okumura
Kazuhiro
K
Terachi
Toshiro
T
Moroi
Seiji
S
Okada
Yusaku
Y
Nishio
Yasunori
Y
Kanamaru
Hirofumi
H
Inui
Masashi
M
Asazuma
Akira
A
Kanatani
Isao
I
Sasaki
Miharu
M
Nishikawa
Nobuyuki
N
Hida
Shuichi
S
Nonomura
Mitsuo
M
Terai
Akito
A
Ogura
Keiji
K
Mitsumori
Kenji
K
Nishimura
Kazuo
K
Onishi
Hiroyuki
H
Horii
Yasuki
Y
Yamasaki
Toshinari
T
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
D010406:Penicillins