title: Bacteraemia during Transurethral Resection of the Prostate: What Are the Risk Factors and Is It More Common than We Think?
abstract: The aim of this work was to investigate the microbial causes, incidence, duration, risk factors and clinical implications of bacteraemia occurring during transurethral resection of the prostate (TURP) surgery to better inform prophylaxis strategies. An ethically approved, prospective, cohort study of patients undergoing TURP was conducted. Clinical information and follow-up details were collected using standardized data collection sheets. Blood was obtained for culture at 6 different time points peri-procedure. Standard of care antibiotic prophylaxis was given prior to surgery. Bacteriuria was assessed in a pre-procedure urine sample. Histopathology from all prostate chips was assessed for inflammation and malignancy. 73 patients were consented and 276 blood samples obtained. No patients developed symptomatic bacteraemia during the procedure, 17 patients developed asymptomatic bacteraemia (23.2%). Enterococcus faecalis and Pseudomonas aeruginosa were the most common organisms cultured. 10 minutes after the start of the TURP, the odds ratio (OR) of developing bacteraemia was 5.38 (CI 0.97-29.87 p = 0.05), and 20 minutes after the start of the procedure, the OR was 6.46 (CI 1.12-37.24, p = 0.03), compared to before the procedure. We also found an association between the development of intra-operative bacteraemia and recent antibiotic use (OR 4.34, CI 1.14-16.62, p = 0.032), the presence of a urinary catheter (OR 4.92, CI 1.13-21.51, p = 0.034) and a malignant histology (OR 4.90, CI 1.30-18.46, p = 0.019). There was no statistical relationship between pre-operative urine culture results and blood culture results. This study shows that asymptomatic bacteraemia is commonly caused by TURP and occurs in spite of antibiotic prophylaxis. Our findings challenge the commonly held view that urine is the primary source of bacteraemia in TURP-associated sepsis and raise the possibility of occult prostatic infection as a cause of bacteraemia. More work will be needed to determine the significance of transient bacteraemia in relation to more serious complications like infective endocarditis and malignancy.
authors.affiliation: Department of Urology, The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester, United Kingdom.
authors.forename: Amar Raj
authors.identifier: http://orcid.org/0000-0002-2672-618X
authors.initials: AR
authors.lastname: Mohee
authors.affiliation: Department of Microbiology, The Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, United Kingdom.
authors.forename: Deborah
authors.initials: D
authors.lastname: Gascoyne-Binzi
authors.affiliation: Department of Biostatistics, The University of Leeds, Woodhouse Lane, Leeds, United Kingdom.
authors.forename: Robert
authors.initials: R
authors.lastname: West
authors.affiliation: Department of Pathology, The Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, United Kingdom.
authors.forename: Selina
authors.initials: S
authors.lastname: Bhattarai
authors.affiliation: Department of Urology, The Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, United Kingdom.
authors.forename: Ian
authors.initials: I
authors.lastname: Eardley
authors.affiliation: University of Leeds and Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, United Kingdom.
authors.forename: Jonathan A T
authors.initials: JA
authors.lastname: Sandoe
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000188:drug therapy*; D016022:Case-Control Studies; D004696:Endocarditis / Q000150:complications; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D011467:Prostate / Q000601:surgery; D011470:Prostatic Hyperplasia / Q000150:complications* / Q000601:surgery; D012307:Risk Factors; D018805:Sepsis / Q000150:complications; D020728:Transurethral Resection of Prostate / Q000009:adverse effects*