Antibiotic prophylaxis practice patterns in patients undergoing transurethral resection or vaporization of the prostate with preoperative catheterization
Sai Allu, BS1, Martus Gn, MD1, Travis Wheeler, BS2, Rebecca Ortiz, BA2, Philip Caffery, PhD2, Christopher Tucci, MS1, Elias Hyams, MD1.
1Minimally Invasive Urology Institute, The Miriam Hospital; The Warren Alpert Medical School of Brown University, Providence, RI, USA, 2Minimally Invasive Urology Institute, The Miriam Hospital, Providence, RI, USA.
BACKGROUND: Patients undergoing transurethral resection of prostate (TURP) or Greenlight vaporization of the prostate (GLPVP) will often have an indwelling catheter or be on clean intermittent catheterization (CIC) prior to surgery. Urinary colonization is common in these patients and the optimal utilization of antibiotic prophylaxis prior to undergoing one of these procedures is unclear. We investigated antibiotic prophylaxis practice patterns at our institution for patients undergoing these procedures as well as infectious complications. METHODS: A single-institution, retrospective review was performed to identify patients who underwent a TURP or GLPVP from 2020-2021. Presence of a preoperative indwelling catheter or CIC regimen, preoperative urine cultures and antibiotics prescribed, and 30-day re-presentation secondary to a urinary tract infection (UTI) were recorded. Statistical analysis was performed using the chi-squared test. RESULTS: In total, 128 patients who underwent a TURP or GLPVP were identified. 50 patients (39.1%) had an indwelling catheter or were performing CIC preoperatively. Patients with an indwelling catheter or on CIC were more likely to have a positive preoperative urine culture (58.0% vs 15.4%; p<0.01). They were also more likely to be treated with antibiotics preoperatively (68.0% vs 19.2; p<0.01) even with a negative preoperative urine culture (28.6% vs 4.6%; p>0.01). Patients with positive urine cultures were likely to be treated with antibiotics preoperatively (96.6% for patients with an indwelling catheter or on CIC vs 100% without; p=0.51). Postoperative antibiotic prescribing rates were similar between the two groups (28.0% vs 26.8%; p=0.89). 2 patients (4%) with an indwelling catheter or on CIC were readmitted within 30 days with a UTI versus no readmissions for patients without an indwelling catheter or on CIC (p=0.08). There was no difference in 30-day readmission rates with a UTI in patients with an indwelling catheter or on CIC who were placed on preoperative antibiotics versus those who were not (2.9% vs 6.3%; p=0.58). CONCLUSIONS: Patients with an indwelling catheter or on CIC are more likely to be treated with antibiotics preoperatively prior to undergoing a TURP or GLPVP, even with a negative preoperative urine culture. The benefit of antibiotic prophylaxis in patients with an indwelling catheter or on CIC remains unclear. Infectious disease consultation generally suggests perioperative prophylaxis only in these patients, though our practice patterns demonstrate more aggressive use of preoperative antibiotics. This issue warrants further attention in prospective studies to determine the optimal balance between effective prophylaxis and good antibiotic stewardship.
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