title: Antibiotic prophylaxis for transurethral prostatic resection in men with preoperative urine containing less than 100,000 bacteria per ml: a systematic review.
abstract: OBJECTIVE
  We determined whether antibiotic prophylaxis can reduce the risk of postoperative infective complications in men undergoing transurethral resection of the prostate (TURP) who have preoperative urine with less than 100,000 bacteria per ml.
  
  
  METHODS
  MEDLINE, EMBASE (Elsevier B.V., Amsterdam, The Netherlands) and the Cochrane Library were searched for randomized and quasi-randomized controlled trials that compared the effects of antibiotic prophylaxis with placebo or active controls for men undergoing TURP with preoperative sterile urine. Two reviewers independently extracted patient characteristic and outcomes data based on a prospectively developed protocol.
  
  
  RESULTS
  A total of 28 trials, 10 placebo controlled and 18 no treatment controlled, involving 4,694 patients, met the inclusion criteria. The mean age of the subjects was 69 years and the majority underwent TURP for prostatic hyperplasia (85%). Antibiotic prophylaxis was significantly more effective than placebo in reducing postoperative TURP complications. The risk differences for post-TURP bacteriuria, high degree fever, bacteremia and use of additional antibiotic treatment were -0.17 (95% CI 0.20, -0.15), -0.11 (-0.15, -0.06), -0.02 (-0.04, 0.00) and -0.20 (-0.28, -0.11), respectively. The results were observed consistently across all classes of antibiotics assessed. There was no difference in the duration of postoperative catheterization or hospitalization. Adverse events were rare, generally mild, and included allergic reactions, pyrexia and abdominal complaints.
  
  
  CONCLUSIONS
  Prophylactic antibiotics decrease the incidence of post-TURP bacteriuria, high fever, bacteremia and additional antibiotic treatment. Additional research should evaluate the optimal antibiotic regimen, and whether the cost and possibility of the development of resistant strains of organisms justify the routine use of prophylactic antibiotics.
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Qiang
authors.forename: Wu
authors.initials: W
authors.lastname: Jianchen
authors.forename: Roderick
authors.initials: R
authors.lastname: MacDonald
authors.forename: Manoj
authors.initials: M
authors.lastname: Monga
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Wilt
mesh_terms: D000368:Aged; D019072:Antibiotic Prophylaxis; D016470:Bacteremia / Q000517:prevention & control; D001437:Bacteriuria / Q000382:microbiology*; D015169:Colony Count, Microbial; D005334:Fever / Q000517:prevention & control; D006801:Humans; D008297:Male; D010919:Placebos; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000517:prevention & control; D020728:Transurethral Resection of Prostate; D016896:Treatment Outcome
chemical_list: D010919:Placebos